Active NPI
Kelly Anne Rayburn, PA-C
- Surgical Physician Assistant
- Jbsa Lackland, TX
National Provider Identifier
1548228398
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA05332
- Practice address
- 1100 Wilford Hall Loop
Jbsa Lackland, TX 78236-5638 - Phone
- (210) 314-0779
- NPI assigned
- May 2, 2006
- Last updated
- Dec 2, 2019
- 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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA05332 | TX | Primary |
Addresses
Primary practice location
1100 Wilford Hall Loop
Jbsa Lackland, TX 78236-5638
Mailing address
10922 Iron SPG
Helotes, TX 78023-4569
Phone (210) 314-0779
Other practice location 1
12709 Toepperwein Rd Ste 101
Live Oak, TX 78233-3259
Phone (210) 477-5151
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 345120501 | Medicaid | TX | |
| P01008379 | Other | TX | RAILROAD MEDICARE |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The University of Texas Health Science Center at San Antonio | Past | Accepting new patients |
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.
-
dba UT Health San Antonio Multispecialty & Research Hospital
- General Acute Care Hospital
- San Antonio, TX
- NPI 1326829904
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575244800000",
"number": "1548228398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10922 IRON SPG",
"city": "HELOTES",
"state": "TX",
"postal_code": "780234569",
"telephone_number": "210-314-0779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP",
"city": "JBSA LACKLAND",
"state": "TX",
"postal_code": "782365638",
"telephone_number": "210-314-0779"
}
],
"practiceLocations": [
{
"address_1": "12709 Toepperwein Rd Ste 101",
"address_purpose": "LOCATION",
"city": "Live Oak",
"state": "TX",
"postal_code": "782333259",
"country_code": "US",
"telephone_number": "210-477-5151",
"fax_number": "210-477-5152",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RAYBURN",
"first_name": "KELLY",
"middle_name": "ANNE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-02",
"last_updated": "2019-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "TX",
"license": "PA05332",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "345120501",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P01008379",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jbsa Lackland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.