NPIMap

Organization Active NPI

Raleys

  • Community/Retail Pharmacy
  • South Lake Tahoe, CA
National Provider Identifier
1215039607
Registry record updated May 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY53481 Issued in CA
Legal business name
RALEYS
Practice address
1040 Emerald Bay Road
South Lake Tahoe, CA 96150-6200
Phone
(530) 541-5410
Fax
(530) 541-8264
NPI assigned
Sep 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2015

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

Authorized official

Name
Helen S Singmaster
Title
Secretary
Phone
(916) 373-6394

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHY53481 CA Primary

Addresses

Primary practice location

1040 Emerald Bay Road
South Lake Tahoe, CA 96150-6200

Mailing address

500 West Capitol Ave.
West Sacramento, CA 95605-2696
Phone (916) 373-6394

Other identifiers 2

IdentifierTypeStateIssuer
1215039607MedicaidCA
0562985OtherNCPDP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040831000246 CA Part B Supplier - Mass Immunization (Roster Biller Only) 2365417722 This NPI is an additional NPI on the enrollment
Practice locations: Sacramento, CA; Petaluma, CA; S Lake Tahoe, CA; Rohnert Park, CA; Rohnert, CA; Redding, CA; Red Bluff, CA; Pleasanton, CA…
O20100930046282 CA DME Supplier - Pharmacy 2365417722 Practice locations: South Lake Tahoe, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Raley'S Pharmacy #1271040 Emerald Bay Rd, South Lake Tahoe, CA 96150-6200(530) 541-5230 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Does not accept assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Raleys 24852 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

Locations

1040 Emerald Bay Rd
South Lake Tahoe, CA 96150
Phone (530) 541-5230

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432857600000",
    "number": "1215039607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 WEST CAPITOL AVE.",
            "city": "WEST SACRAMENTO",
            "state": "CA",
            "postal_code": "956052696",
            "telephone_number": "916-373-6394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 EMERALD BAY ROAD",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961506200",
            "telephone_number": "530-541-5410",
            "fax_number": "530-541-8264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RALEYS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2015-05-29",
        "status": "A",
        "authorized_official_last_name": "SINGMASTER",
        "authorized_official_first_name": "HELEN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "916-373-6394"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY53481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215039607",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0562985",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Lake Tahoe, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.