Individual provider Active NPI

Kristin M. Rayball, D.C., C.C.S.P.

  • Sports Physician Chiropractor
  • Fairfield, CT
National Provider Identifier
1760433494
Registry record updated Dec 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
1556 Issued in CT
Practice address
340 Post Rd
Fairfield, CT 06824-6220
Phone
(203) 259-3210
Fax
(203) 259-3213
NPI assigned
May 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician Chiropractor 111NS0005X 1556 CT Primary

Addresses

Primary practice location

340 Post Rd
Fairfield, CT 06824-6220

Mailing address

340 Post Rd
Fairfield, CT 06824-6220
Phone (203) 259-3210

Other identifiers 1

IdentifierTypeStateIssuer
004239803MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1556CTMDAddiction (Substance Use Disorder) Counselor
001556CTMDClinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Chiropractic Associates of Bridgeport Past Accepting new patients
Physical Synergy, LLC PastSince Sep 12, 2005 Accepting new patients
Chiropractic Associates of Bridgeport, LLC PastSince Sep 1, 2013 Accepting new patients

Organizations & group practices 3

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": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291161600000",
    "number": "1760433494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 POST RD",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246220",
            "telephone_number": "203-259-3210",
            "fax_number": "203-259-3213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 POST RD",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246220",
            "telephone_number": "203-259-3210",
            "fax_number": "203-259-3213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAYBALL",
        "first_name": "KRISTIN",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "D.C., C.C.S.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-15",
        "last_updated": "2010-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "CT",
            "license": "1556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004239803",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.