Jill Maven Gray, PSYD, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP3557 Issued in MN

Practice address

4201 Excelsior Blvd
St Louis Park, MN 55416-4728

Phone

(952) 933-8900

Fax

(952) 945-9536

NPI assigned

Sep 16, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Dr. Jill Marie Adams Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Family Innovations IncGroup PAC ID 6204178528, 96 clinicians

Mental Health Specialty Group PAGroup PAC ID 8921466228, 726 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Locations

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.

• Family Innovations, Inc.

  • Counseling Psychologist
  • Anoka, MN
  • NPI 1992862783

  Clinical

  Medicare reassignment Care Compare group NPD
• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  MN

  Medicare reassignment Care Compare group NPD
• Minnesota Medical and Rehabilitative Services, LLC

  • Physical Therapist
  • St. Louis Park, MN
  • NPI 1154302545
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  MN

  Medicare reassignment NPD
• West Central Counseling LLC

  • Mental Health Counselor
  • Alexandria, MN
  • NPI 1649846650
  NPD (past)

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650844800000",
    "number": "1124124045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164728",
            "telephone_number": "952-933-8900",
            "fax_number": "952-945-9536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164728",
            "telephone_number": "952-933-8900",
            "fax_number": "952-945-9536"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "63 Aspen Pt",
            "address_purpose": "LOCATION",
            "city": "Landfall Village",
            "state": "MN",
            "postal_code": "551287111",
            "country_code": "US",
            "telephone_number": "651-341-2014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAY",
        "first_name": "JILL",
        "middle_name": "MAVEN",
        "name_prefix": "Dr.",
        "credential": "PSYD, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-16",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP3557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "920215300",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA - UBH",
            "identifier": "61-56740",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BS",
            "identifier": "996N6AJ",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "ADAMS",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "credential": "LP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• James Grant
• Lucreshia Grant, MS
• Shelly Grant, LICSW
• Steven Christopher Gravatt
• Kera L T Graves, OTR/L
• Mary Helen Gray, R.N., N.P
• Paul W Gray, CRNA
• Janet Grayson, MD
• Elliot Graziano
• Kristen Marie Graziano

• Clinical Psychologist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.