Bernardus E Ray, CFA PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

CN 2545 Issued in FL

Practice address

15 Broadmoor Rd
Rotonda West, FL 33947-1901

Phone

(941) 830-0584

NPI assigned

May 17, 2007

Last updated

Jul 8, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1609083724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3313",
            "city": "BAY ST LOUIS",
            "state": "MS",
            "postal_code": "395213313",
            "telephone_number": "228-342-3831",
            "fax_number": "985-845-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 BROADMOOR RD",
            "city": "ROTONDA WEST",
            "state": "FL",
            "postal_code": "339471901",
            "telephone_number": "941-830-0584"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "230 Audubon Dr",
            "address_purpose": "LOCATION",
            "city": "Mandeville",
            "state": "LA",
            "postal_code": "70471",
            "country_code": "US",
            "telephone_number": "985-845-1501",
            "fax_number": "985-845-1601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1700 Tamiami Trl",
            "address_purpose": "LOCATION",
            "city": "Sarasota",
            "state": "FL",
            "postal_code": "342393509",
            "country_code": "US",
            "telephone_number": "941-917-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAY",
        "first_name": "BERNARDUS",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "CFA PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "CN 2545",
            "primary": true
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "VA",
            "license": "0136000230",
            "primary": false
        },
        {
            "code": "246ZX2200X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Orthopedic Assistant",
            "state": "FL",
            "license": "1131",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NAT C OF ASSIST SURGEONS",
            "identifier": "CN2545",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Rotonda West, FL
• Providers in Rotonda West, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.