NPIMap

Individual provider Active NPI

Kyra Ray, MD

  • Family Medicine Physician
  • Vallejo, CA
National Provider Identifier
1154948925
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
182952 Issued in CA
Practice address
415 Georgia St
Vallejo, CA 94590-6004
Phone
(707) 556-8100
NPI assigned
Jun 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 182952 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

415 Georgia St
Vallejo, CA 94590-6004

Mailing address

415 Georgia St
Vallejo, CA 94590-6004

Other practice location 1

210 Hospital Dr
Vallejo, CA 94589-2517
Phone (707) 645-7316

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231026003404 CA Practitioner - Family Practice 6901200666 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
La Clinica de la Raza IncGroup PAC ID 1557258282, 130 clinicians

Practice addresses (Care Compare)

415 Georgia St
Vallejo, CA 94590-6004
Phone (707) 556-8100

Hospital & facility affiliations

  • Sutter Solano Medical Center Hospital, Vallejo, CA, CCN 050101

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
182952CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
La Clinica de la Raza Inc CurrentSince Oct 1, 2023 Accepting new patients
La Clinica de la Raza Inc CurrentSince Oct 1, 2023 Accepting new patients
La Clinica de la Raza Inc Current Accepting new patients
La Clinica de la Raza, Inc. Past Accepting new patients

Locations

210 Hospital Dr
Vallejo, CA 94589
Phone (707) 645-7316

415 Georgia St
Vallejo, CA 94590
Phone (707) 556-8100

220 Hospital Dr
Vallejo, CA 94589
Phone (707) 641-1900

Organizations & group practices 12

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1593302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1154948925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 GEORGIA ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945906004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 GEORGIA ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945906004",
            "telephone_number": "707-556-8100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "210 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Vallejo",
            "state": "CA",
            "postal_code": "945892517",
            "country_code": "US",
            "telephone_number": "707-645-7316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAY",
        "first_name": "KYRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-28",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "182952",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vallejo, CA

Sources for this page

Verify at the official NPI Registry.