Active NPI
Lisa Marie Ray, PA
- Physician Assistant
- Jacksonville, FL
National Provider Identifier
1437185410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 004601
- Practice address
- 1 Shircliff Way
Jacksonville, FL 32204 - Phone
- (904) 308-7300
- Fax
- (912) 355-5324
- NPI assigned
- Jun 23, 2006
- Last updated
- Jan 28, 2013
- 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 | 004601 | GA | Primary |
Addresses
Primary practice location
1 Shircliff Way
Jacksonville, FL 32204
Mailing address
PO Box 863026
Orlando, FL 32886-3026
Phone (800) 288-8325
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 816135739 | Medicaid | GA |
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 |
|---|---|---|---|
| 004601 | GA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Pediatric Specialists LLC | Past | Accepting new patients |
Interoperability endpoints
- lisa.ray.1@27536.direct.athenahealth.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pediatrics Physician
- Savannah, GA
- NPI 1073046397
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359331200000",
"number": "1437185410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 863026",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328863026",
"telephone_number": "800-288-8325",
"fax_number": "419-866-5453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 SHIRCLIFF WAY",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32204",
"telephone_number": "904-308-7300",
"fax_number": "912-355-5324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAY",
"first_name": "LISA",
"middle_name": "MARIE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-23",
"last_updated": "2013-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "004601",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "816135739",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.