RADIANCE KETAMINE CLINIC
NPI 1861036063
Family Medicine in Reno, NV

Q: What is Pride Medical Spa And Wellness Center Inc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since October 30, 2019CLIA 29D2172792 · Waiver

6380 MAE ANNE AVE, UNIT 7, RENO, NV 89523(775) 432-1500(775) 432-1002 Get Directions Write a Review

NPPES record last updated: April 24, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 24, 2024, Dec 17, 2019, Nov 25, 2019 and 1 more (4 updates tracked since 2019).

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About Radiance Ketamine Clinic NPPES

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

RADIANCE KETAMINE CLINIC (NPI 1861036063) is a healthcare organization registered as a family medicine in Reno, Nevada and active in the NPI registry since October 2019. The organization holds a CLIA Waiver certificate valid through September 29, 2027 and lists Greg Jones, Clinic Administrator, as its authorized official.

NPPES Registry Identity

NPI1861036063

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NamePRIDE MEDICAL SPA AND WELLNESS CENTER INC

Location Address6380 MAE ANNE AVE, UNIT 7Reno, NV 89523-4712

Mailing Address6380 Mae Anne Ave, Unit 7Reno, NV 89523-4712 · (775) 432-1500 · Fax (775) 432-1002

Phone(775) 432-1500

Fax(775) 432-1002

Organization SubpartNo

Authorized OfficialGreg JonesClinic Administrator · (775) 432-1500

Enumeration DateOctober 30, 2019

Last NPPES UpdateApril 24, 20244 updates tracked since enumeration

NPPES CertifiedDecember 17, 2019

✔ NPI 1861036063 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

6380 MAE ANNE AVE, Reno, NV 89523

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Other Names 1

Doing Business AsRadiance Ketamine Clinic

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 2 clinicians reassign Medicare billing to Radiance Ketamine Clinic, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Francisco Dofeliz, M.D.

Family Practice

NPI 1891043832

6380 MAE ANNE AVE UNIT 7
Reno, NV 89523

(775) 432-1500

✔ PECOS✔ Accepts MedicareSame address

Emmanuelle Garcia-Rider, MD

Psychiatry

NPI 1407359250

5190 NEIL RD STE 215
Reno, NV 89502

(775) 682-8469

✔ PECOS✔ Accepts Medicare6.8 mi

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 29D2172792

Radiance Ketamine Clinic · Reno, NV

Active · expires Sep 29, 2027

CLIA Number29D2172792

Laboratory TypePhysician Office

Certificate Effective DateSeptember 30, 2025

Certificate Expiration DateSeptember 29, 2027

Laboratory DirectorFrancisco L. Dofeliz

Laboratory Phone(775) 432-1500

Laboratory LocationRadiance Ketamine Clinic6380 Mae Anne Ave Ste 7, Reno, NV 89523

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

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 Pride Medical Spa And Wellness Center Inc's NPI number?

The NPI number for Pride Medical Spa And Wellness Center Inc is 1861036063. It was assigned to this organization in the NPPES registry on October 30, 2019. The provider is doing business as Radiance Ketamine Clinic.

Where is Pride Medical Spa And Wellness Center Inc located?

Pride Medical Spa And Wellness Center Inc is located at 6380 Mae Anne Ave Unit 7, Reno, NV 89523. The listed phone number is (775) 432-1500.

What is Pride Medical Spa And Wellness Center Inc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Pride Medical Spa And Wellness Center Inc enrolled in Medicare?

Yes. Pride Medical Spa And Wellness Center Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Pride Medical Spa And Wellness Center Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Pride Medical Spa And Wellness Center Inc, in Family Practice and Psychiatry. 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. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Pride Medical Spa And Wellness Center Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 29D2172792) is associated with this NPI, valid through September 29, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Pride Medical Spa And Wellness Center Inc accept?

Health plans from Molina Healthcare list Pride Medical Spa And Wellness Center Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Pride Medical Spa And Wellness Center Inc was last updated on April 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.