Larissa Faith Gray, PA-C

Key facts

NPI

1083344758

Entity type

Individual (NPI type 1)

Primary specialty

Physician Assistant 363A00000X

License

PA1038 (WY)

Practice address

1522 E a St
Casper, WY 82601-2254

Phone

(307) 234-6161

NPI assigned

Jun 14, 2022

Sex

Female

Sole proprietor

No

Organizations & group practices 3

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.

• University of Wyoming Federally Qualified Health Center (FQHC) · Cheyenne, WY · NPI 1770681439
  Medicare reassignment Care Compare group NPD (past) FAMILY MEDICINE · WY
• University of Wyoming Federally Qualified Health Center (FQHC) · Laramie, WY · NPI 1639617061
  Care Compare group NPD (past) FAMILY MEDICINE
• University of Wyoming Federally Qualified Health Center (FQHC) · Casper, WY · NPI 1558657650
  Care Compare group

Hospital & facility affiliations 2

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

• Casper Home Health, LLC Home Health Agency · Casper, WY · NPI 1336652452
  Care Compare affiliation Home health agency
• Wyoming Medical Center Inc General Acute Care Hospital · Casper, WY · NPI 1346332954
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Wyoming (40 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Casper Home Health LLC Home health agency · Casper, WY · CCN 537084
• Banner Wyoming Medical Center Hospital · Casper, WY · CCN 530012

Medicare participation

Medicare fee-for-service enrollment

Enrolled in WY

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: larissa.gray.1@30244.direct.athenahealth.com

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 25, 2023.

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677283200000",
    "number": "1083344758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4227 MINK",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826044509",
            "telephone_number": "307-234-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1522 E A ST",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826012254",
            "telephone_number": "307-234-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "LARISSA",
        "middle_name": "FAITH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-14",
        "last_updated": "2023-02-25",
        "certification_date": "2023-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WY",
            "license": "PA1038",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WY",
            "license": "PA1038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michael J. Granum, M.D.
• Constance Blaine Grau, DO
• Venese Ann Graunke, MSN, FNP-C
• Desiree Kandra Gray-Mefferd
• Jenadene Gray, MSW
• Mariah Grayson
• Great West Ambulance Service
• Cathy Green, LCSW
• Damon S Green, PA-C
• Jarred Matthew Green

All providers in Casper, WY · Physician Assistant in Wyoming