NPIMap

Individual provider Active NPI

Ray S. Kusumoto, PA

  • Medical Physician Assistant
  • Hollister, CA
National Provider Identifier
1194850800
Registry record updated Mar 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA13954 Issued in CA
Practice address
591 McCray St Ste 231
Hollister, CA 95023-2224
Phone
(831) 636-3116
Fax
(831) 636-1204
NPI assigned
Feb 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA13954 CA Primary

Addresses

Primary practice location

591 McCray St Ste 231
Hollister, CA 95023-2224

Mailing address

591 McCray St Ste 231
Hollister, CA 95023-2224
Phone (831) 636-3116

Other practice location 1

890 Sunset Dr
Suite A2
Hollister, CA 95023-5651
Phone (831) 636-3116

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
I20090805000363 CA Practitioner - Physician Assistant 9638144264 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bass Medical GroupGroup PAC ID 9032111281, 292 clinicians

Practice addresses (Care Compare)

384 Pearson Dr
Porterville, CA 93257-3368
Phone (559) 625-4118

591 McCray St
Hollister, CA 95023-2224
Phone (831) 636-3116

Hospital & facility affiliations

  • Bonita Springs Home Health LLC Home health agency, Gilroy, CA, CCN 053142
  • Ascension Healthcare Services Home health agency, Campbell, CA, CCN 059765
  • Sehaj Home Health, Inc Home health agency, Fremont, CA, CCN 059705
  • Central Coast Vna & Hospice, Inc Home health agency, Monterey, CA, CCN 057002
  • Hazel Hawkins Memorial Hospital Hospital, Hollister, CA, CCN 051337
  • Stanford Health Care Hospital, Stanford, CA, CCN 050441

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA13954CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bass Medical Group CurrentSince Jun 18, 2024 Accepting new patients
Bass Medical Group CurrentSince Jun 18, 2024 Accepting new patients
Bass Medical Group Past Accepting new patients
Bass Medical Group Past Accepting new patients
Felicidad G Lao-Domingo MD Inc Past Accepting new patients

Locations

243 Green Valley Rd
Ste B
Freedom, CA 95019
Phone (831) 724-9449

591 McCray St
Ste 231
Hollister, CA 95023
Phone (831) 636-3116

591 McCray St
Ste 211
Hollister, CA 95023
Phone (831) 636-3116

901 Sunset Dr
Ste 3
Hollister, CA 95023
Phone (831) 636-3116

384 Pearson Dr
Porterville, CA 93257
Phone (559) 781-5179

2637 Shadelands Dr
Walnut Creek, CA 94598
Phone (925) 627-3424

365 Lennon Ln
Ste 250
Walnut Creek, CA 94598
Phone (925) 627-3424

Interoperability endpoints

  • Direct secure messaging: ray.kusumoto.1@25176.direct.athenahealth.com
  • Direct secure messaging: ray.kusumoto@hhch.eclinicaldirectplus.com

Organizations & group practices 6

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 12

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": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741046400000",
    "number": "1194850800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "591 MCCRAY ST STE 231",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950232224",
            "telephone_number": "831-636-3116",
            "fax_number": "831-636-1204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 MCCRAY ST STE 231",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950232224",
            "telephone_number": "831-636-3116",
            "fax_number": "831-636-1204"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "890 Sunset Dr",
            "address_2": "Suite A2",
            "address_purpose": "LOCATION",
            "city": "Hollister",
            "state": "CA",
            "postal_code": "950235651",
            "country_code": "US",
            "telephone_number": "831-636-3116",
            "fax_number": "831-636-1204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUSUMOTO",
        "first_name": "RAY",
        "middle_name": "S.",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-22",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA13954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollister, CA

Sources for this page

Verify at the official NPI Registry.