Individual provider Active NPI

Nicklya M. Harris-Ray, DPM

  • Podiatrist
  • Mandeville, LA
National Provider Identifier
1609829472
Registry record updated Feb 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
DPM200002 Issued in LA
Practice address
1401 Florida St
Mandeville, LA 70448-5433
Phone
(786) 395-1573
NPI assigned
May 19, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X E4806 CA
Podiatrist 213E00000X DPM200002 LA Primary

Addresses

Primary practice location

1401 Florida St
Mandeville, LA 70448-5433

Mailing address

45 Hardy Court Ctr
Ste 136
Gulfport, MS 39507-2501
Phone (786) 395-1573

Other identifiers 2

IdentifierTypeStateIssuer
1582671MedicaidLA
P00440632OtherLAMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060622000157 LA Practitioner - Podiatry 3173535721 Reassigns benefits to 1 organization
Practice locations: Lacombe, LA; Mandeville, LA

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Barry University School of Podiatric Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aria Podiatry Care PLLCGroup PAC ID 2567822661, 53 clinicians

Practice addresses (Care Compare)

830 S Broadway St
Church Point, LA 70525-4402
Phone (877) 674-1211

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1829
Removal or shaving of skin growth24

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
200002LAMDFamily Medicine Physician
E4806CAMDPodiatrist
DPM200002LAMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Aria Podiatry Care PLLC Podiatrist CurrentSince Jan 13, 2025 Accepting new patients
Aria Dental Care PC Past Accepting new patients
Bayou Foot Care, LLC Podiatrist Past Accepting new patients
Bayou Foot Care, LLC Past Accepting new patients

Locations

8500 W 110th St
Ste 450
Overland Park, KS 66210
Phone (913) 362-1112

830 S Broadway St
Church Point, LA 70525
Phone (337) 684-6313

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740614400000",
    "number": "1609829472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 HARDY COURT CTR",
            "address_2": "STE 136",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395072501",
            "telephone_number": "786-395-1573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 FLORIDA ST",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704485433",
            "telephone_number": "786-395-1573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS-RAY",
        "first_name": "NICKLYA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-19",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E4806",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "LA",
            "license": "DPM200002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1582671",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00440632",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mandeville, LA

Sources for this page

Verify at the official NPI Registry.