Active NPI
Shannon Ray, PA-C
- Physician Assistant
- Makawao, HI
National Provider Identifier
1366492860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- AMD221
- Practice address
- 1120A Makawao Ave
Makawao, HI 96768-9448 - Phone
- (808) 573-2222
- Fax
- (808) 829-3673
- NPI assigned
- May 12, 2006
- Sex
- Female
- Sole proprietor
- No
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 | AMD221 | HI | Primary |
Addresses
Primary practice location
1120A Makawao Ave
Makawao, HI 96768-9448
Mailing address
64-1032 Mamalahoa Hwy
Ste 306
Kamuela, HI 96743-8441
Phone (808) 969-1427
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in HI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AMD221 | HI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pukalani Family Practice, LLC | Past | Accepting new patients | |
| Market Street Clinic, Inc. | Past | Accepting new patients |
Interoperability endpoints
- shannon.ray@103911382974468.direct.elationemr.com
- https://fhir4.healow.com/fhir/r4/JCBAAA
- shannon.ray@551607899127812.direct.elationemr.com
Organizations & group practices 4
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.
-
- Family Medicine Physician
- Kamuela, HI
- NPI 1376837997
-
- Primary Care Clinic/Center
- Hana, HI
- NPI 1346784139
-
- Health Maintenance Organization
- Wailuku, HI
- NPI 1275798928
-
- Primary Care Clinic/Center
- Makawao, HI
- NPI 1063009207
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470787200000",
"number": "1366492860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "64-1032 MAMALAHOA HWY",
"address_2": "STE 306",
"city": "KAMUELA",
"state": "HI",
"postal_code": "967438441",
"telephone_number": "808-969-1427",
"fax_number": "808-961-4795"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120A MAKAWAO AVE",
"city": "MAKAWAO",
"state": "HI",
"postal_code": "967689448",
"telephone_number": "808-573-2222",
"fax_number": "808-829-3673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAY",
"first_name": "SHANNON",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-12",
"last_updated": "2016-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "HI",
"license": "AMD221",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Makawao, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; 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.