Courtney Rose Gray, AGPCNP-BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

2017040265 Issued in MO

Practice address

1390 US Highway 61 Ste N1500
Festus, MO 63028

Phone

(636) 933-5055

NPI assigned

Jan 19, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Courtney Rose Pottgen Professional name

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Clinic Heart and Vascular LLCGroup PAC ID 8820016207, 112 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Jefferson Hospital, Crystal City, MO, CCN 260023

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Interoperability endpoints

• Direct secure messaging: cgray525285@directc.mercy.net

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.

• Mercy Clinic Heart and Vascular, LLC

  • Cardiovascular Disease Physician
  • Saint Louis, MO
  • NPI 1932176401
  Medicare reassignment Care Compare group
• Mercy Clinic Cardiovascular and Thoracic Surgery, LLC

  • Vascular Surgery Physician
  • Washington, MO
  • NPI 1528192416
  NPD (past)
• Cei Physicians PSC LLC

  dba CVP Surgery Center

  • Ophthalmologic Surgery Clinic/Center
  • Blue Ash, OH
  • NPI 1790772804
  NPD (past)

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

• Mercy Hospital Jefferson

  • General Acute Care Hospital
  • Festus, MO
  • NPI 1508859661
  Care Compare affiliation

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

{
    "created_epoch": "1516320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536192000000",
    "number": "1215445622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 SHADOW OAK DR",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630283376",
            "telephone_number": "314-401-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1390 US HIGHWAY 61 STE N1500",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "63028",
            "telephone_number": "636-933-5055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 US Highway 61 Ste 240B",
            "address_purpose": "LOCATION",
            "city": "Festus",
            "state": "MO",
            "postal_code": "630284141",
            "country_code": "US",
            "telephone_number": "636-933-2344",
            "fax_number": "636-937-9031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "620 Maple Valley Dr",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "MO",
            "postal_code": "636401976",
            "country_code": "US",
            "telephone_number": "636-933-5055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAY",
        "first_name": "COURTNEY",
        "middle_name": "ROSE",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-19",
        "last_updated": "2018-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2017040265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "POTTGEN",
            "middle_name": "ROSE",
            "credential": "NP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jacob D Graham, DPT
• Taylor Gravatt, LPC
• Amber Sue Gray, LMSW
• Cara Gray
• Christopher Charles Gray, D.O.
• Tammy Elva Grayum, RD, LD
• James D Green, FNP
• Laurie D Greer-Retzer
• Gregg a Ginsburg MD PC
• Camille Grove

• Adult Health Nurse Practitioner in Festus, MO
• Providers in Festus, MO by specialty
• Adult Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2018; 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.