Individual provider Active NPI

Ronald H Raybon, PA

  • Physician Assistant
  • Glendale, AZ
National Provider Identifier
1740497379
Registry record updated May 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2023 Issued in AZ
Practice address
5410 W Thunderbird Rd Ste 101
Glendale, AZ 85306-4711
Phone
(602) 530-6189
NPI assigned
May 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2023 AZ Primary

Addresses

Primary practice location

5410 W Thunderbird Rd Ste 101
Glendale, AZ 85306-4711

Mailing address

8201 Golf Course Rd NW Ste A3
Albuquerque, NM 87120-5803
Phone (505) 800-7070

Other practice location 1

8201 Golf Course Rd NW
Albuquerque, NM 87120-5842
Phone (505) 800-7070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, NM2 enrollments
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.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100923001081 AZ Practitioner - Physician Assistant 4385760685 Reassigns benefits to 2 organizations
I20220628002039 NM Practitioner - Physician Assistant 4385760685 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2023AZMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lovelace Urgent Care, LLC Internal Medicine CurrentSince Apr 1, 2025 Accepting new patients

Locations

8201 Golf Course Rd NW
Ste A3
Albuquerque, NM 87120
Phone (505) 800-7070

Interoperability endpoints

  • Direct secure messaging: ronald.raybonpac.p1@direct.nextcare.nextgenshare.com

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": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716940800000",
    "number": "1740497379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8201 GOLF COURSE RD NW STE A3",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871205803",
            "telephone_number": "505-800-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5410 W THUNDERBIRD RD STE 101",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064711",
            "telephone_number": "602-530-6189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8201 Golf Course Rd NW",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871205842",
            "country_code": "US",
            "telephone_number": "505-800-7070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAYBON",
        "first_name": "RONALD",
        "middle_name": "H",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-16",
        "last_updated": "2024-05-29",
        "certification_date": "2022-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "2023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.