Stacey Kim Raya, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

000938 Issued in CT

Practice address

200 Queen St
Southington, CT 06489-1901

Phone

(860) 621-2225

Fax

(860) 621-2868

NPI assigned

Oct 20, 2005

Last updated

Sep 10, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Advanced Back Center

  • Chiropractor
  • Southington, CT
  • NPI 1043486947
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347235200000",
    "number": "1073502134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 QUEEN ST",
            "city": "SOUTHINGTON",
            "state": "CT",
            "postal_code": "064891901",
            "telephone_number": "860-621-2225",
            "fax_number": "860-621-2868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 QUEEN ST",
            "city": "SOUTHINGTON",
            "state": "CT",
            "postal_code": "064891901",
            "telephone_number": "860-621-2225",
            "fax_number": "860-621-2868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAYA",
        "first_name": "STACEY",
        "middle_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-20",
        "last_updated": "2012-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CT",
            "license": "000938",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA/USHEALTHCARE",
            "identifier": "0124979",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "050000938CT01",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "954",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LANDMARK",
            "identifier": "0V1745",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P414597",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Psychiatric Wellnes Center, LLC
• Michelle Queen, LPC
• Nazer Qureshi, MD
• R.P. Soutter Enterprises, Inc. (Harvest Medical & Surgical Supplies)
• Lee Raspet, RPH
• Matthew Patrick Raymond, D.O.
• Scott Raymond
• Katie Reigel
• Relaxing Tone CT
• Restorative Counseling Services LLC

• Chiropractor in Southington, CT
• Providers in Southington, CT by specialty
• Chiropractor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.