Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ryan T McCulloch, PA

Individual provider Physician Assistant · NPI 1720195530

Ryan T McCulloch, PA is a Physician Assistant in Chubbuck, Idaho. Graduated from University of Nebraska College of Medicine in 2002, 24 years ago. Practices with Idaho Skin Institute LLC, a 9-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
24
Trained at
University of Nebraska College of Medicine
Licensed in
ID
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

147 W Chubbuck Rd
Chubbuck, ID 83202-2314
Phone: (208) 238-7546
Fax: (208) 237-9643
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA405 (ID)

Record details

NPI number1720195530
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedAugust 25, 2006
Last updated in NPPESDecember 20, 2010
Mailing address147 W Chubbuck Rd, Chubbuck, ID 83202-2314

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolUNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE
Graduated 2002 (24 years in practice)
Group practice Idaho Skin Institute Llc — 9 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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