Victoria Gladden Rain, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9118307 Issued in FL

Practice address

73-5618 Maiau St Ste A204
Kailua Kona, HI 96740-2634

Phone

(808) 329-1146

Fax

(808) 329-1120

NPI assigned

Dec 26, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 14, 2024 through Oct 14, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• University Park Dermatology PLLC

  • Dermatology Physician
  • Sarasota, FL
  • NPI 1043221997
  NPD
• Monica Scheel MD LLC

  • Dermatology Physician
  • Kailua Kona, HI
  • NPI 1396173506
  NPD (past)
• Ronald L Moy MD Inc

  • MOHS-Micrographic Surgery Physician
  • Beverly Hills, CA
  • NPI 1558693424
  NPD (past)

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

{
    "created_epoch": "1703548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1609645191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13834",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323173834",
            "telephone_number": "850-205-6232",
            "fax_number": "855-975-0615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73-5618 MAIAU ST STE A204",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967402634",
            "telephone_number": "808-329-1146",
            "fax_number": "808-329-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAIN",
        "first_name": "VICTORIA",
        "middle_name": "GLADDEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-26",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9118307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Princess Joy Domngo
• Anne Marie Provax, MFT
• Puna Plantation Hawaii, LTD.
• Janelle Quinn
• R & S Enterprises Inc
• Ramona T. Estrada
• Gabriella Iakel Ramos
• Nandini Rampersaud
• Rosemary Rast, L.AC.
• Thomas C Rayson, M.D.

• Physician Assistant in Kailua Kona, HI
• Providers in Kailua Kona, HI by specialty
• Physician Assistant in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.