Individual provider Active NPI

Abbey P. Raynor, PA-C

  • Medical Physician Assistant
  • San Tan Valley, AZ
National Provider Identifier
1073846853
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
4497 Issued in AZ
Practice address
37100 N Gantzel Rd Ste 106
San Tan Valley, AZ 85140-7350
Phone
(480) 821-3600
Fax
(480) 821-3610
NPI assigned
Sep 11, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 4497 AZ Primary
Physician Assistant 363A00000X 4497 AZ

Addresses

Primary practice location

37100 N Gantzel Rd Ste 106
San Tan Valley, AZ 85140-7350

Mailing address

PO Box 6730
Chandler, AZ 85246-6730
Phone (480) 821-3600

Other identifiers 1

IdentifierTypeStateIssuer
489181MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100223000787 AZ Practitioner - Physician Assistant 2668516055 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Momdoc LLCGroup PAC ID 3375534282, 62 clinicians

Practice addresses (Care Compare)

21300 N John Wayne Pkwy
Maricopa, AZ 85139-8978
Phone (480) 821-3600

37100 N Gantzel Rd
Suite 106
San Tan Valley, AZ 85140-7350
Phone (480) 821-3600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4497AZMDVeterinarian

Practice roles

OrganizationSpecialtyStatusNew patients
Healthy Pregnancy Perinatology, LLC Past Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1252627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1073846853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6730",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852466730",
            "telephone_number": "480-821-3600",
            "fax_number": "480-821-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37100 N GANTZEL RD STE 106",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851407350",
            "telephone_number": "480-821-3600",
            "fax_number": "480-821-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAYNOR",
        "first_name": "ABBEY",
        "middle_name": "P.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-11",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "4497",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "4497",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "489181",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Tan Valley, AZ

Sources for this page

Verify at the official NPI Registry.