SHANNON RAY (PA-C) – Physician Assistant, NPI 1366492860
Physician Assistant
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for SHANNON RAY (PA-C)
Kamuela Kitchen & Coffee Bar, 64-1056 A, Mamalahoa Highway, Kuhio Village, Waimea/Kamuela CDP, Hawaiʻi County, Hawaii, United States
STE 306
KAMUELA, HI 967438441
Phone: (808) 969-1427
Fax: (808) 961-4795
Type: Mailing
1120, Makawao Avenue, Makawao, Maui County, Hawaii, 96768, United States
MAKAWAO, HI 967689448
Phone: (808) 573-2222
Fax: (808) 829-3673
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $35.
Total Amount is formed as General ($35) + Research ($0) + Ownership ($0) = $35.
Last reported payment date: 2024-08-14 • Largest payer in this snapshot: Shionogi Inc ($19).
Total Amount
$35
General + Research + Ownership
Payments
2
Total payment records
General Amount
$35
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-14
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Shionogi Inc | $19 |
| ABIOMED | $16 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-08-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040811001197 | I | Physician Assistant | HI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 96743)
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