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INNERBLOOM KETAMINE THERAPY
NPI 1184430696
Integrative Medicine in San Luis Obispo, CA

Active since December 09, 2024
100 CASA ST STE D3, SAN LUIS OBISPO, CA 93405(805) 321-8471(805) 567-6604 Get Directions Write a Review

NPPES record last updated: March 3, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 3, 2026, Dec 9, 2024 (2 updates tracked since 2024).

About Innerbloom Ketamine Therapy NPPES

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

INNERBLOOM KETAMINE THERAPY (NPI 1184430696) is a healthcare organization registered as an integrative medicine in San Luis Obispo, California and active in the NPI registry since December 2024. The organization lists Ray Rivas, Md, as its authorized official.

NPPES Registry Identity

NPI1184430696
Entity TypeOrganization
Primary Taxonomy202D00000X
Legal Business NameINNERBLOOM KETAMINE THERAPY
Location Address100 CASA ST STE D3San Luis Obispo, CA 93405-5827
Mailing Address100 Casa St Ste D3San Luis Obispo, CA 93405-5827 · (805) 321-8471 · Fax (805) 567-6604
Phone(805) 321-8471
Fax(805) 567-6604
Organization SubpartNo
Authorized OfficialRay RivasMd · (805) 321-8471
Enumeration DateDecember 9, 2024
Last NPPES UpdateMarch 3, 20262 updates tracked since enumeration
NPPES CertifiedMarch 3, 2026
✔ NPI 1184430696 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntegrative MedicineAllopathic & Osteopathic Physicians
Taxonomy Code202D00000X
Definition
A physician who specializes in the treatment of the whole person through prevention and treatment based on medical evidence. Integrative medicine considers all factors that influence health, wellness, and disease – including mind, body, and spirit. Conventional and alternative methods are used to facilitate the body’s innate healing response. Appropriate consideration is given to use of less-invasive and less-harmful interventions, when possible. It also incorporates all appropriate therapeutic approaches, health care modalities, and disciplines to achieve optimal health and healing.
100 CASA ST STE D3, San Luis Obispo, CA 93405
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Innerbloom Ketamine Therapy is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Innerbloom Ketamine Therapy, which bills Medicare for the services this clinician delivers.

Clinician (1)

Ray Rivas, M.D.
General Surgery
NPI 1003173816
100 CASA ST STE D3
San Luis Obispo, CA 93405
(805) 321-8471
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Innerbloom Ketamine Therapy's NPI number?

The NPI number for Innerbloom Ketamine Therapy is 1184430696. It was assigned to this organization in the NPPES registry on December 9, 2024.

Where is Innerbloom Ketamine Therapy located?

Innerbloom Ketamine Therapy is located at 100 Casa St Ste D3, San Luis Obispo, CA 93405. The listed phone number is (805) 321-8471.

What is Innerbloom Ketamine Therapy's specialty?

The primary specialty registered for this NPI is Integrative Medicine with taxonomy code 202D00000X.

Is Innerbloom Ketamine Therapy enrolled in Medicare?

Yes. Innerbloom Ketamine Therapy is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Innerbloom Ketamine Therapy?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (General Surgery) reassigns their Medicare billing to Innerbloom Ketamine Therapy. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Innerbloom Ketamine Therapy was last updated on March 3, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months 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.