Active NPI
Tamma L Johnson-Gray, DDS
- General Practice Dentistry
- Baker, LA
National Provider Identifier
1013079839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8170
- Practice address
- 3508 Groom Rd
Baker, LA 70714-3508 - Phone
- (225) 774-3934
- NPI assigned
- Dec 15, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8170 | TN | Primary |
| Dentist | 122300000X | 6435 | LA |
Addresses
Primary practice location
3508 Groom Rd
Baker, LA 70714-3508
Mailing address
1153 Cornerstone Dr
Baton Rouge, LA 70810-4774
Phone (225) 953-3576
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6435 | LA | MD | Dentist |
| 8170 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| HIV-AIDS Alliance for Region Two | Current | Accepting new patients |
Locations
3801 North Blvd
Baton Rouge, LA 70806
Phone (225) 381-6620
Networks
- MS PPO C-SNP
- MS PPO D-SNP
- TX HMO D-SNP
- LA PPO C-SNP
Interoperability endpoints
- https://api.platform.athenahealth.com/12694/brand/1/csg/1/fhir/r4
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Baton Rouge, LA
- NPI 1437527900
-
- Federally Qualified Health Center (FQHC)
- Baton Rouge, LA
- NPI 1891551818
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428451200000",
"number": "1013079839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1153 CORNERSTONE DR",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708104774",
"telephone_number": "225-953-3576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3508 GROOM RD",
"city": "BAKER",
"state": "LA",
"postal_code": "707143508",
"telephone_number": "225-774-3934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON-GRAY",
"first_name": "TAMMA",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-15",
"last_updated": "2015-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TN",
"license": "8170",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "LA",
"license": "6435",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baker, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.