George Thompson Gray III, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R3735 Issued in AR

Practice address

1400 Braden St
Emergency Dept
Jacksonville, AR 72076-3721

Phone

(501) 985-7000

NPI assigned

Apr 14, 2006

Last updated

Jun 19, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Forrest City Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Forrest City, AR
  • NPI 1497080501
  Medicare reassignment NPD
• Southeast Arkansas Emergency Physicians LLP

  • Emergency Medicine Physician
  • Pine Bluff, AR
  • NPI 1922475078
  Medicare reassignment NPD
• Greenbrier Emergency Services, Inc.

  • Emergency Medicine Physician
  • Gassaway, WV
  • NPI 1568401461

  AR

  Medicare reassignment NPD
• Forrest City Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Hope, AR
  • NPI 1760897904
  NPD
• Southeast Arkansas Emergency Physicians LLP

  • Emergency Medicine Physician
  • Pine Bluff, AR
  • NPI 1467817411
  NPD
• Jacksonville Emergency Medicine LLC

  • Emergency Medicine Physician
  • Jacksonville, AR
  • NPI 1093044166
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340064000000",
    "number": "1023072105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3925",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711333925",
            "telephone_number": "800-684-0052",
            "fax_number": "405-844-1794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BRADEN ST",
            "address_2": "EMERGENCY DEPT",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720763721",
            "telephone_number": "501-985-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "GEORGE",
        "middle_name": "THOMPSON",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2012-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "R-3735",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "R3735",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113616003",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCARE",
            "identifier": "P01027353",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mika Tamara Gill, LMSW
• April Glasgow, QBHP
• John Glenn
• Isabella Noelle Gordon
• GPN Jacksonville LLC
• Gregory K. Bollen, DDS, P.a.
• Deana Grisham, LPN
• Josh Guerra, QBHP
• Ashlyne Guinn, QBHP
• Meaghan Hainzer, CRNP

• Family Medicine Physician in Jacksonville, AR
• Providers in Jacksonville, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; 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.

Verify at the official NPI Registry.