Ray Herman Rivas, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A164066 Issued in CA

Practice address

100 Casa St Ste D3
San Luis Obispo, CA 93405-5827

Phone

(805) 321-8471

Fax

(805) 567-6604

NPI assigned

Apr 18, 2012

Last updated

Feb 3, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

University of North Dakota School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ray.rivas.1@33079.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Innerbloom Ketamine Therapy

  • Integrative Medicine Physician
  • San Luis Obispo, CA
  • NPI 1184430696

  Single Specialty

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770076800000",
    "number": "1003173816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CASA ST STE D3",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934055827",
            "telephone_number": "805-321-8471",
            "fax_number": "805-567-6604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CASA ST STE D3",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934055827",
            "telephone_number": "805-321-8471",
            "fax_number": "805-567-6604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVAS",
        "first_name": "RAY",
        "middle_name": "HERMAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-18",
        "last_updated": "2026-02-03",
        "certification_date": "2026-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A164066",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A164066",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD OF CALIFORNIA",
            "identifier": "A164066",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.https://innerbloomketamine.com/",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Website",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Website",
            "address_1": "100 Casa St Ste D3",
            "city": "San Luis Obispo",
            "state": "CA",
            "country_code": "US",
            "postal_code": "934055827",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rise Medical Services
• Rite Aid Pharmacy
• Jethro Trees Ritter, D.O.
• Stacey Jensen Ritter, ATC
• Cecilia Rivas
• Araceli Rivera
• Christina Lynn Rivera
• Kryzto Rivera, PT
• Marisa R Rivera, MSW
• Raphael Rizk

• Psychiatry Physician in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.