NPIMap

Individual provider Active NPI

Keriann Nickola Gray, M.D.

  • Hematology & Oncology Physician
  • State College, PA
National Provider Identifier
1023215670
Registry record updated May 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
MD456589 Issued in PA
Practice address
200 Scenery Dr.
State College, PA 16801-5602
Phone
(814) 231-4560
Fax
(814) 231-6246
NPI assigned
Jun 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X MD456589 PA Primary
Hematology & Oncology Physician 207RH0003X 246232 NY
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

200 Scenery Dr.
State College, PA 16801-5602

Mailing address

PO Box 14890
Albany, NY 12212-4890
Phone (518) 525-5634

Other practice location 1

1300 Massachusetts Ave
Troy, NY 12180-1628
Phone (518) 268-5060

Other practice location 2

317 S Manning Blvd Ste 220
Albany, NY 12208-3909
Phone (518) 525-6418

Other practice location 3

1 Tallow Wood Dr
Clifton Park, NY 12065-2807
Phone (518) 268-5060

Other identifiers 1

IdentifierTypeStateIssuer
464500OtherPAMEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, PA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101202000947 NY Practitioner - HematologyPractitioner - Internal Medicine 3577750561 Reassigns benefits to 2 organizations
I20160104000833 PA Practitioner - Internal MedicinePractitioner - Hematology/Oncology 3577750561 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HematologyAlso: Internal Medicine
Education
State University of New York at Buffalo School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Peters Hospital of the City of AlbanyGroup PAC ID 2668460072, 268 clinicians

Practice addresses (Care Compare)

317 S Manning Blvd
Suite 220
Albany, NY 12208-3909
Phone (518) 525-6418

Hospital & facility affiliations

  • St Peter'S Hospital Hospital, Albany, NY, CCN 330057
  • Samaritan Hospital of Troy, New York Hospital, Troy, NY, CCN 330180
  • Sunnyview Hospital and Rehabilitation Center Hospital, Schenectady, NY, CCN 330406
  • Albany Medical Center Hospital Hospital, Albany, NY, CCN 330013

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
246232NYMDHematology & Oncology Physician
MD456589PAMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Hospital of Troy, New York Hematology & Oncology CurrentSince Sep 30, 2019 Accepting new patients
Geisinger Clinic CurrentSince Jan 25, 2016 Accepting new patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Jan 25, 2016 Accepting new patients
St. Peter'S Hospital of the City of Albany CurrentSince Sep 30, 2019 Accepting new patients
St. Peter'S Hospital of the City of Albany CurrentSince Sep 30, 2019 Accepting new patients

Locations

315 S Manning Blvd
Albany, NY 12208
Phone (518) 525-1852

317 S Manning Blvd
Ste 220
Albany, NY 12208
Phone (518) 525-6418

1 Tallow Wood Dr
Clifton Park, NY 12065
Phone (518) 373-4444

2215 Burdett Ave
Troy, NY 12180
Phone (518) 271-3300

1300 Massachusetts Ave
Troy, NY 12180
Phone (518) 268-5000

100 N Academy Ave
Danville, PA 17822

200 Scenery Dr
State College, PA 16801
Phone (814) 231-4560

Interoperability endpoints

  • Direct secure messaging: kgray789289@direct.trinity-health.org
  • Direct secure messaging: kgray@direct.health-quest.org

Organizations & group practices 6

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1023215670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14890",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122124890",
            "telephone_number": "518-525-5634",
            "fax_number": "518-649-4094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SCENERY DR.",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168015602",
            "telephone_number": "814-231-4560",
            "fax_number": "814-231-6246"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1300 Massachusetts Ave",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "NY",
            "postal_code": "121801628",
            "country_code": "US",
            "telephone_number": "518-268-5060",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "317 S Manning Blvd Ste 220",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122083909",
            "country_code": "US",
            "telephone_number": "518-525-6418",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Tallow Wood Dr",
            "address_purpose": "LOCATION",
            "city": "Clifton Park",
            "state": "NY",
            "postal_code": "120652807",
            "country_code": "US",
            "telephone_number": "518-268-5060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAY",
        "first_name": "KERIANN",
        "middle_name": "NICKOLA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-28",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "PA",
            "license": "MD456589",
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NY",
            "license": "246232",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "464500",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "317 S Manning Blvd Ste 220",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "122083909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.