NPIMap

Individual provider Active NPI

Burgandy Gray

  • Physician Assistant
  • Horseheads, NY
National Provider Identifier
1063800464
Registry record updated Mar 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
018372 Issued in NY
Practice address
3005 Watkins Rd
Horseheads, NY 14845-1800
Phone
(607) 739-8711
NPI assigned
Jan 7, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA057364 PA
Physician Assistant 363A00000X 018372 NY Primary

Addresses

Primary practice location

3005 Watkins Rd
Horseheads, NY 14845-1800

Mailing address

571 Saint Josephs Blvd
FL 2
Elmira, NY 14901-3230
Phone (607) 271-2050

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150319000069 NY Practitioner - Physician Assistant 4082931670 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arnot Ogden Medical CenterGroup PAC ID 5395798417, 219 clinicians

Practice addresses (Care Compare)

200 Madison Ave
Elmira, NY 14901-3219

600 Roe Ave
Elmira, NY 14905-1629

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.15 of 100Reported as group
Quality
46.76
Promoting interoperability
100
Improvement activities
40
Cost
77.08

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA057364PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Arnot Ogden Medical Center CurrentSince Dec 17, 2018 Accepting new patients
Arnot Ogden Medical Center CurrentSince Dec 17, 2018 Accepting new patients

Locations

200 Madison Ave
Fl 3
Elmira, NY 14901
Phone (607) 734-1581

600 Roe Ave
Elmira, NY 14905
Phone (607) 733-3639

600 Roe Ave
Ste 1F
Elmira, NY 14905
Phone (607) 795-8161

200 Madison Ave
Ste 1D
Elmira, NY 14901
Phone (607) 873-1832

Interoperability endpoints

  • Direct secure messaging: burgandy.gray@arn.eclinicaldirectplus.com

Organizations & group practices 5

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 7

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": "1420588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552521600000",
    "number": "1063800464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "571 SAINT JOSEPHS BLVD",
            "address_2": "FL 2",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013230",
            "telephone_number": "607-271-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3005 WATKINS RD",
            "city": "HORSEHEADS",
            "state": "NY",
            "postal_code": "148451800",
            "telephone_number": "607-739-8711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "BURGANDY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-07",
        "last_updated": "2019-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA057364",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Horseheads, NY

Sources for this page

Verify at the official NPI Registry.