NPIMap

Individual provider Active NPI

Lily Wray

  • Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1417640301
Registry record updated Jan 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2350 International Cir
Colorado Springs, CO 80910-3139
Phone
(719) 475-5065
NPI assigned
May 29, 2023
Last updated
Jan 13, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2350 International Cir
Colorado Springs, CO 80910-3139

Mailing address

2279 Sable Chase Dr
Colorado Springs, CO 80920-6712

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230807000694 NM Practitioner - Physician Assistant 3173984275 Reassigns benefits to 3 organizations
I20250805004417 CO Practitioner - Physician Assistant 3173984275 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Agewell Medical Associates PCGroup PAC ID 8527164466, 6 clinicians

Practice addresses (Care Compare)

2350 International Cir
Colorado Springs, CO 80910-3139
Phone (719) 475-5065

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Eldercare Physician Services LLC CurrentSince Jun 24, 2023 Accepting new patients
Genesis Eldercare Physician Services LLC CurrentSince Jun 24, 2023 Accepting new patients

Locations

5123 Juan Tabo Blvd NE
Albuquerque, NM 87111
Phone (505) 292-3333

5900 Forest Hills Dr NE
Albuquerque, NM 87109
Phone (505) 514-2900

1831 Camino del Llano
Belen, NM 87002
Phone (505) 864-1600

1650 Galisteo St
Santa Fe, NM 87505
Phone (505) 984-8313

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1685318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768262400000",
    "number": "1417640301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2279 SABLE CHASE DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809206712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 INTERNATIONAL CIR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809103139",
            "telephone_number": "719-475-5065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRAY",
        "first_name": "LILY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-29",
        "last_updated": "2026-01-13",
        "certification_date": "2026-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.