NPIMap

Individual provider Active NPI

Carly Jean Gray, PA

  • Medical Physician Assistant
  • Moyock, NC
National Provider Identifier
1174929095
Registry record updated Nov 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0010-06904 Issued in NC
Practice address
534 Caratoke Hwy
Moyock, NC 27958-8740
Phone
(252) 435-6621
Fax
(252) 435-2685
NPI assigned
Nov 5, 2014
Last updated
Nov 19, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0110004737 VA
Medical Physician Assistant 363AM0700X 0010-06904 NC Primary

Addresses

Primary practice location

534 Caratoke Hwy
Moyock, NC 27958-8740

Mailing address

PO Box 11314
Belfast, ME 04915-4004
Phone (757) 842-4481

Other names 1

  • Carly J Smith Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150106001035 VA Practitioner - Physician Assistant 4385967900 Reassigns benefits to 1 organization
I20170221001558 NC Practitioner - Physician Assistant 4385967900 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Duke University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chesapeake Regional Medical GroupGroup PAC ID 8426113663, 148 clinicians

Practice addresses (Care Compare)

534 Caratoke Hwy
Moyock, NC 27958-8740
Phone (252) 435-6621

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-06904NCMDMedical Physician Assistant
0110004737VAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Chesapeake Regional Medical Group CurrentSince Nov 27, 2016 Accepting new patients
Bayview Physician Services, PC CurrentSince Nov 1, 2014 Accepting new patients
Bayview Physician Services, PC CurrentSince Nov 1, 2014 Accepting new patients

Locations

534 Caratoke Hwy
Moyock, NC 27958
Phone (252) 435-6621

111 Mill Creek Pkwy
Chesapeake, VA 23323
Phone (757) 558-8210

3241 Western Branch Blvd
Chesapeake, VA 23321
Phone (757) 686-3500

1708 Old Donation Pkwy
Virginia Beach, VA 23454
Phone (757) 395-5300

Interoperability endpoints

  • Direct secure messaging: carly.gray.1@5072.direct.athenahealth.com

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

Hospital & facility affiliations 4

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": "1415145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1174929095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11314",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154004",
            "telephone_number": "757-842-4481",
            "fax_number": "757-312-3135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "534 CARATOKE HWY",
            "city": "MOYOCK",
            "state": "NC",
            "postal_code": "279588740",
            "telephone_number": "252-435-6621",
            "fax_number": "252-435-2685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "CARLY",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-05",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110004737",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-06904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "SMITH",
            "middle_name": "J",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Moyock, NC

Sources for this page

Verify at the official NPI Registry.