DR. DERISSA FOLASADE RAYNOLD MD
NPI 1083351506
Student in an Organized Health Care Education/Training Program in Kalamazoo, MI

Q: What is Derissa Raynold's NPI number?

The NPI number for Derissa Raynold is 1083351506. It was assigned to this individual provider in the NPPES registry on May 16, 2022.

Q: What is Derissa Raynold's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Derissa Raynold was last updated on May 27, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 16, 2022PECOS Enrolled

1000 OAKLAND DR, KALAMAZOO, MI 49008(269) 337-4600 Get Directions Write a Review

NPPES record last updated: May 27, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 27, 2022, May 16, 2022 (2 updates tracked since 2022).

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About Dr. Derissa Folasade Raynold Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DERISSA FOLASADE RAYNOLD MD (NPI 1083351506) is an individual student in an organized health care education/training program in Kalamazoo, Michigan, licensed in Michigan (4351049698) and active in the NPI registry since May 2022. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1083351506

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameDR. DERISSA FOLASADE RAYNOLDCredential: MD

Location Address1000 OAKLAND DRKalamazoo, MI 49008-1282

Mailing Address1000 Oakland DrKalamazoo, MI 49008-1282

Phone(269) 337-4600

Sole ProprietorNo

Enumeration DateMay 16, 2022

Last NPPES UpdateMay 27, 20222 updates tracked since enumeration

NPPES CertifiedMay 27, 2022

✔ NPI 1083351506 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

License✔ Licensed in MI · 4351049698

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1000 OAKLAND DR, Kalamazoo, MI 49008

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Derissa Folasade Raynold Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDREW MATTINGLY MD

Student in an Organized Health Care Education/Training Program