Individual provider Active NPI

Jon Jordan Gray, MD

  • Emergency Medicine Physician
  • Austin, TX
National Provider Identifier
1073044384
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
V3868 Issued in TX
Practice address
15 Waller St
Austin, TX 78702-5240
Phone
(512) 978-0000
NPI assigned
Mar 27, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 35.138405 OH
Emergency Medicine Physician 207P00000X 21319 NH
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X V3868 TX
Emergency Medicine Physician 207P00000X V3868 TX Primary

Addresses

Primary practice location

15 Waller St
Austin, TX 78702-5240

Mailing address

15 Waller St
Austin, TX 78702-5240
Phone (512) 978-0000

Other practice location 1

One Medical Center Dr
Lebanon, NH 03756-0001
Phone (603) 650-7254

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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

Enrollment IDStateProvider typePAC IDDetails
I20210519000337 NH Practitioner - Emergency Medicine 4082988415 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
79.66 of 100Reported as apm
Quality
53.51
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
79.66 of 100Reported as apm
Quality
53.51
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21319NHMDEmergency Medicine Physician
35.138405OHMDEmergency Medicine Physician
V3868TXMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alice Peck Day Memorial Hospital Emergency Medical Services Current Accepting new patients
Alice Peck Day Memorial Hospital CurrentSince May 11, 2021 Accepting new patients
Dartmouth-Hitchcock Clinic Emergency Medicine CurrentSince May 11, 2021 Accepting new patients
Alice Peck Day Memorial Hospital CurrentSince May 11, 2021 Accepting new patients

Locations

1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922

5 Alice Peck Day Dr
Lebanon, NH 03766
Phone (603) 448-3996

Interoperability endpoints

  • FHIR API: https://edhwebportal.hitchcock.org/FHIRProxy/api/FHIR/R4/

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735171200000",
    "number": "1073044384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 WALLER ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787025240",
            "telephone_number": "512-978-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 WALLER ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787025240",
            "telephone_number": "512-978-0000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "One Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "NH",
            "postal_code": "037560001",
            "country_code": "US",
            "telephone_number": "603-650-7254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAY",
        "first_name": "JON",
        "middle_name": "JORDAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-27",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35.138405",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NH",
            "license": "21319",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "TX",
            "license": "V3868",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "V3868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.