Organization Active NPI

Eric I Ray MD PLLC

  • Physical Medicine & Rehabilitation Physician
  • Southlake, TX
National Provider Identifier
1699100024
Registry record updated May 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
M8943 Issued in TX
Legal business name
ERIC I RAY MD PLLC
Practice address
731 E Southlake Blvd
Suite 110
Southlake, TX 76092-6377
Phone
(817) 898-7277
Fax
(817) 527-5119
NPI assigned
Sep 4, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2014

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

Authorized official

Name
Eric Issac Ray, MDNPI 1598965428
Title
Owner/President
Phone
(817) 898-7277

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X M8943 TX Primary

Addresses

Primary practice location

731 E Southlake Blvd
Suite 110
Southlake, TX 76092-6377

Mailing address

731 E Southlake Blvd
Suite 110
Southlake, TX 76092-6377
Phone (817) 898-7277

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20131121001506 TX Part B Supplier - Clinic/Group Practice 2860628856 Receives reassigned benefits from 1 practitioner
Practice locations: Southlake, TX
O20140512001702 TX DME Supplier - Physician - Physical and Rehabilitation 2860628856 Practice locations: Southlake, TX

National Provider Directory

National Provider Directory

Locations

731 E Southlake Blvd
Ste 110
Southlake, TX 76092
Phone (817) 527-5119

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399939200000",
    "number": "1699100024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 E SOUTHLAKE BLVD",
            "address_2": "SUITE 110",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926377",
            "telephone_number": "817-898-7277",
            "fax_number": "817-527-5119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 E SOUTHLAKE BLVD",
            "address_2": "SUITE 110",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926377",
            "telephone_number": "817-898-7277",
            "fax_number": "817-527-5119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIC I RAY MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-04",
        "last_updated": "2014-05-13",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "ISSAC",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "817-898-7277",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "TX",
            "license": "M8943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.