Salvatore Di Raffaele, PA-C, D.C.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2005 Issued in ID

Practice address

1090 W Park PL
Coeur D Alene, ID 83814-2785

Phone

(208) 415-0299

NPI assigned

Jan 15, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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 and National Provider Directory roles.

• Gem Medical Group Corporation

  • Emergency Medicine Physician
  • Whittier, CA
  • NPI 1689364721

  CA

  Medicare reassignment NPD
• Clinica del Socorro Medical Group,Inc.

  • Family Medicine Physician
  • Los Angeles, CA
  • NPI 1215263827

  CA

  Medicare reassignment
• Golden West Emergency Medical Associates, Inc

  • Emergency Medicine Physician
  • Monterey Park, CA
  • NPI 1053680298

  CA

  Medicare reassignment

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1154472256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1387",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838351387",
            "telephone_number": "208-415-0299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 W PARK PL",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142785",
            "telephone_number": "208-415-0299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "611 Colorado Ave",
            "address_purpose": "LOCATION",
            "city": "Santa Monica",
            "state": "CA",
            "postal_code": "904012507",
            "country_code": "US",
            "telephone_number": "310-245-3814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DI RAFFAELE",
        "first_name": "SALVATORE",
        "name_prefix": "Dr.",
        "credential": "PA-C,   D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-15",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "14822",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "2005",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "2005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jillian Devine
• William Riley Devine
• Kelcie Christine Devitt, LMSW
• Colleen K Devlin, LMSW
• Angeli Di Lucca
• Linda J Diamond, DIETITIAN
• Delwyn Lee Dick, D.D.S.
• Penelope Dill, LMFT
• Grace Traal Dillman, CNA
• Rebecca Dillman

• All providers in Coeur D Alene, ID
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.