Gray Derm PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

GRAY DERM PLLC

Practice address

750 W High St Ste 300
Lima, OH 45801-2967

Phone

(419) 229-6781

Fax

(614) 386-9506

NPI assigned

Oct 22, 2018

Organization subpart

No

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

Authorized official

Name

Bryan Gray, DONPI 1831514025

Title

DO/Practice Owner

Phone

(614) 596-6789

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 2

• Gray Derm LLC Doing business as
• Gray Dermatology & Cosmetic Surgery Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bryan Gray, DO

  • Dermatology Physician
  • Lima, OH
  • NPI 1831514025

  Multi-Specialty

  Medicare reassignment Care Compare group NPD Authorized official
• Michelle Gene Renko

  • Family Nurse Practitioner
  • Lancaster, OH
  • NPI 1912283250

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Nari Lee, MD

  • Dermatology Physician
  • Boston, MA
  • NPI 1952884371
  NPD
• Lindsay McCormack, MD

  • Dermatology Physician
  • Wellesley, MA
  • NPI 1831765148
  NPD
• Lisa R Jordan, CNP

  • Family Nurse Practitioner
  • Lima, OH
  • NPI 1356650055
  NPD (past)
• Haley Elise Gravely, PA-C

  • Physician Assistant
  • Poulsbo, WA
  • NPI 1043942766
  NPD (past)

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

{
    "created_epoch": "1540166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770163200000",
    "number": "1104392679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 W HIGH ST STE 300",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458012967",
            "telephone_number": "419-229-6781",
            "fax_number": "614-386-9506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 W HIGH ST STE 300",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458012967",
            "telephone_number": "419-229-6781",
            "fax_number": "614-386-9506"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "609 E Chestnut St",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "OH",
            "postal_code": "431303900",
            "country_code": "US",
            "telephone_number": "740-206-7131",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1005 Bellefontaine Ave Ste 300",
            "address_purpose": "LOCATION",
            "city": "Lima",
            "state": "OH",
            "postal_code": "458042881",
            "country_code": "US",
            "telephone_number": "419-998-8297",
            "fax_number": "419-226-8309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRAY DERM PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-22",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "DO/PRACTICE OWNER",
        "authorized_official_telephone_number": "614-596-6789",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OH LICENSE",
            "identifier": "34.013501",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI LICENSE",
            "identifier": "5101021720",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bgray@grayderm.ezderm.info",
            "affiliation": "N",
            "endpointDescription": "direct messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "525 N Eastown Rd Ste A",
            "city": "Lima",
            "state": "OH",
            "country_code": "US",
            "postal_code": "458072268",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Gray Derm LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gray Dermatology & Cosmetic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ludmila Gott, CNP
• Sheila Gottfried, LPN
• Tejas Gowda, DO
• Rachael Graham, ATC
• Kristen Diane Gravitt
• Bryan Gray, DO
• Heather M Gray, DPM
• Danielle Green, MSW
• Emily Green
• Florence E Green, LPN

• Dermatology Physician in Lima, OH
• Providers in Lima, OH by specialty
• Dermatology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.