NPIMap

Individual provider Active NPI

Jesse Phillip Wray

  • Emergency Medicine Physician
  • Elmendorf AFB, AK
National Provider Identifier
1679076988
Registry record updated Jan 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
175597 Issued in AK
Practice address
Jber Emergency Department
5955 Zeamer Ave
Elmendorf AFB, AK 99506
Phone
(870) 514-6421
NPI assigned
Mar 13, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 175597 AK Primary

Addresses

Primary practice location

Jber Emergency Department
5955 Zeamer Ave
Elmendorf AFB, AK 99506

Mailing address

Jber Emergency Department
5955 Zeamer Ave
Elmendorf AFB, AK 99506
Phone (907) 580-5556

Other practice location 1

250 Hospital Pl
Soldotna, AK 99669-6999
Phone (907) 714-4529

Other identifiers 1

IdentifierTypeStateIssuer
1726717MedicaidAK

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jwray2336856@ak.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220315001200 AK Practitioner - Emergency Medicine 7517362858 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

250 Hospital PL
Soldotna, AK 99669-7559
Phone (907) 714-4515

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.9 of 100Reported as group
Quality
76.07
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
75.44 of 100Reported as group
Quality
62.56
Promoting interoperability
81
Improvement activities
40
Cost
67.88

Merit-based Incentive Payment System (MIPS)

Final score
70.59 of 100Reported as group
Quality
83.37
Promoting interoperability
100
Improvement activities
40
Cost
16.65

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
175597AKMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mat-Su Emergency Medicine Physicians Corp Emergency Medicine CurrentSince Mar 1, 2022 Accepting new patients
Central Peninsula General Hospital Inc. Current Accepting new patients
South Peninsula Hospital, Inc CurrentSince Feb 1, 2023 Accepting new patients
Central Peninsula General Hospital, Inc CurrentSince Jan 22, 2024 Accepting new patients
Central Peninsula General Hospital, Inc CurrentSince Jan 22, 2024 Accepting new patients
North Star Medical Imaging PLLC Current Accepting new patients
South Peninsula Hospital, Inc. Emergency Medicine CurrentSince Feb 1, 2023 Accepting new patients

Locations

4300 Bartlett St
Homer, AK 99603
Phone (907) 235-0369

10128 Kenai Spur Hwy
Kenai, AK 99611
Phone (907) 714-5740

2500 S Woodworth Loop
Palmer, AK 99645
Phone (907) 861-6000

250 Hospital Pl
Soldotna, AK 99669
Phone (907) 714-4404

Interoperability endpoints

  • Direct secure messaging: jwray2336856@ak.providencedirect.org

Organizations & group practices 7

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.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1520899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705708800000",
    "number": "1679076988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "JBER EMERGENCY DEPARTMENT",
            "address_2": "5955 ZEAMER AVE",
            "city": "ELMENDORF AFB",
            "state": "AK",
            "postal_code": "99506",
            "telephone_number": "907-580-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "JBER EMERGENCY DEPARTMENT",
            "address_2": "5955 ZEAMER AVE",
            "city": "ELMENDORF AFB",
            "state": "AK",
            "postal_code": "99506",
            "telephone_number": "870-514-6421"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 Hospital Pl",
            "address_purpose": "LOCATION",
            "city": "Soldotna",
            "state": "AK",
            "postal_code": "996696999",
            "country_code": "US",
            "telephone_number": "907-714-4529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WRAY",
        "first_name": "JESSE",
        "middle_name": "PHILLIP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-13",
        "last_updated": "2024-01-20",
        "certification_date": "2024-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AK",
            "license": "175597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1726717",
            "state": "AK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwray2336856@ak.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "250 Hospital Pl",
            "city": "Soldotna",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996696999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elmendorf AFB, AK

Sources for this page

Verify at the official NPI Registry.