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MR. RAY S. KUSUMOTO PA
NPI 1194850800
Physician Assistant - Medical in Hollister, CA

Active since February 22, 2007PECOS EnrolledAccepts Medicare Assignment
591 MCCRAY ST STE 231, HOLLISTER, CA 95023(831) 636-3116(831) 636-1204 Get Directions Write a Review

NPPES record last updated: March 4, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Ray S. Kusumoto Pa NPPES

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

MR. RAY S. KUSUMOTO PA (NPI 1194850800) is an individual medical provider in Hollister, California, licensed in California (PA13954) and active in the NPI registry since February 2007. He is enrolled in Medicare PECOS, maintains a secondary practice location in Hollister, and is a graduate of Other (1996).

NPPES Registry Identity

NPI1194850800
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameMR. RAY S. KUSUMOTOCredential: PA
Location Address591 MCCRAY ST STE 231Hollister, CA 95023-2224
Mailing Address591 Mccray St Ste 231Hollister, CA 95023-2224 · (831) 636-3116 · Fax (831) 636-1204
Phone(831) 636-3116
Fax(831) 636-1204
Sole ProprietorNo
Medical School CMSOtherGraduated 1996
Enumeration DateFebruary 22, 2007
Last NPPES UpdateMarch 4, 2025
NPPES CertifiedMarch 4, 2025
✔ NPI 1194850800 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in CA · PA13954
591 MCCRAY ST STE 231, Hollister, CA 95023
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Secondary Practice Location 1

Location 1890 Sunset Dr, Suite A2Hollister, CA 95023-5651 · Phone (831) 636-3116 · Fax (831) 636-1204

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Ray S. Kusumoto Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9638144264
PECOS Enrollment IDI20090805000363
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.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
14 services14 patients

Referred Medical Equipment & Supplies CMS DME claims 17

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
10 suppliers60 claims139 services$5.99 avg. paid by Medicare
Normal, low and high calibrator solution / chips A4256
DME-Other DME · category DE000N
3 suppliers11 claims12 services$2.94 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
10 suppliers27 claims37 services$1.15 avg. paid by Medicare
Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
8 suppliers30 claims30 services$33.80 avg. paid by Medicare
Full face mask used with positive airway pressure device, each A7030
DME-Other DME · category DE001N
4 suppliers18 claims18 services$78.37 avg. paid by Medicare
Face mask interface, replacement for full face mask, each A7031
DME-Other DME · category DE001N
4 suppliers17 claims49 services$29.11 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 6

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

AMELIA UNDERWOOD I RD, CDE, PA-C
Physician Assistant
591 MCCRAY ST STE 231
HOLLISTER, CA 95023
San Benito County (831) 444-2289
ANITA SAMANEGO TOLENTINO-MACARAEG M.D.
Pediatrics
591 MCCRAY ST STE 231
HOLLISTER, CA 95023
San Benito County (831) 636-3116
MARIE JULIE SPENCER CPNP
Nurse Practitioner (Pediatrics)
591 MCCRAY ST STE 231
HOLLISTER, CA 95023
San Benito County (831) 636-3116
MR. JOSEPH GODBOUT PA-C
Physician Assistant
591 MCCRAY ST STE 231
HOLLISTER, CA 95023
San Benito County (831) 636-3116
OLIVIA HOANG-OANH TRAN PA
Physician Assistant
591 MCCRAY ST STE 231
HOLLISTER, CA 95023
San Benito County (831) 636-3116
TAYLOR SNOW
Physician Assistant
591 MCCRAY ST STE 231
HOLLISTER, CA 95023
San Benito County (831) 636-3116

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 Ray Kusumoto's NPI number?

The NPI number for Ray Kusumoto is 1194850800. It was assigned to this individual provider in the NPPES registry on February 22, 2007.

Where is Ray Kusumoto located?

Ray Kusumoto practices at 591 Mccray St Ste 231, Hollister, CA 95023. The listed phone number is (831) 636-3116.

What is Ray Kusumoto's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Ray Kusumoto enrolled in Medicare?

Yes. Ray Kusumoto is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Ray Kusumoto was last updated on March 4, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.