Individual provider Active NPI

Charles Lee Gray Jr., FNP-BC

  • Family Nurse Practitioner
  • Baileyton, AL
National Provider Identifier
1144801143
Registry record updated Jul 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1-102412 Issued in AL
Practice address
105 Fire Station Rd
Baileyton, AL 35019-9609
Phone
(256) 735-4057
NPI assigned
Apr 20, 2021
Last updated
Jul 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1-102412 AL Primary

Addresses

Primary practice location

105 Fire Station Rd
Baileyton, AL 35019-9609

Mailing address

105 Fire Station Rd
Baileyton, AL 35019-9609
Phone (256) 735-4057

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL lee.gray1969@gmail.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211227000000 AL Practitioner - Nurse Practitioner 7416348644 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aderholt Medical LLCGroup PAC ID 3577972611, 4 clinicians

Practice addresses (Care Compare)

111 S Marion St
Suite B
Athens, AL 35611-2552
Phone (256) 230-5280

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1-102412ALMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aderholt Medical, LLC Single Specialty CurrentSince Jul 1, 2024 Accepting new patients
Daily Medical, LLC Single Specialty CurrentSince Sep 1, 2021 Accepting new patients
Med Plus, Inc Single Specialty Past Accepting new patients

Locations

111 S Marion St
Athens, AL 35611
Phone (256) 230-5280

111 S Marion St
Ste B
Athens, AL 35611
Phone (256) 230-5280

1207 E Forrest St
Ste 204D
Athens, AL 35613
Phone (256) 230-5280

105 Fire Station Rd
Baileyton, AL 35019
Phone (256) 735-4057

Interoperability endpoints

  • Direct secure messaging: charles.gray@dailymed.directbygreenway.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1618876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1144801143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 FIRE STATION RD",
            "city": "BAILEYTON",
            "state": "AL",
            "postal_code": "350199609",
            "telephone_number": "256-735-4057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 FIRE STATION RD",
            "city": "BAILEYTON",
            "state": "AL",
            "postal_code": "350199609",
            "telephone_number": "256-735-4057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "CHARLES",
        "middle_name": "LEE",
        "name_suffix": "Jr.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-20",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-102412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "lee.gray1969@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "105 Fire Station Rd",
            "city": "Baileyton",
            "state": "AL",
            "country_code": "US",
            "postal_code": "350199609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baileyton, AL

Sources for this page

Verify at the official NPI Registry.