Active NPI
Ray Burton Bloss III, PA-C
- Physician Assistant
- Glendale, CA
National Provider Identifier
1174733265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA18262
- Practice address
- 222 W Eulalia St
Suite #101
Glendale, CA 91204-2849 - Phone
- (818) 246-4800
- Fax
- (818) 246-4805
- NPI assigned
- May 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA18262 | CA | Primary |
Addresses
Primary practice location
222 W Eulalia St
Suite #101
Glendale, CA 91204-2849
Mailing address
15701 Tulsa St
Granada Hills, CA 91344-5524
Phone (443) 765-9149
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 157 | WY | MD | Marriage & Family Therapist |
| PA18262 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Contee Emergency Physicians | Physician Assistant | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Laurel, MD
- NPI 1710936398
Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174733265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15701 TULSA ST",
"city": "GRANADA HILLS",
"state": "CA",
"postal_code": "913445524",
"telephone_number": "443-765-9149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 W EULALIA ST",
"address_2": "SUITE #101",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912042849",
"telephone_number": "818-246-4800",
"fax_number": "818-246-4805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOSS",
"first_name": "RAY",
"middle_name": "BURTON",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA18262",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.