NPIMap

Organization Active NPI

Gary M McCray MD SC

  • Geriatric Medicine (Internal Medicine) Physician
  • Lagrange Park, IL
National Provider Identifier
1255512976
Registry record updated Oct 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
036-064789 Issued in IL
Legal business name
GARY M MCCRAY MD SC
Practice address
1530 Alima Terrace
Lagrange Park, IL 60526-1331
Phone
(708) 783-5572
Fax
(708) 482-4093
NPI assigned
Nov 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2008

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

Authorized official

Name
Dr. Gary Myles McCray, M.D.NPI 1023025541
Title
Owner
Phone
(708) 783-5572

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0300X 036-064789 IL Primary

Addresses

Primary practice location

1530 Alima Terrace
Lagrange Park, IL 60526-1331

Mailing address

1530 Alima Terrace
Lagrange Park, IL 60526-1331
Phone (708) 783-5572

Other identifiers 1

IdentifierTypeStateIssuer
039-064789MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050509000126 IL Part B Supplier - Clinic/Group Practice 0345280400 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
Practice locations: Hillside, IL; Willowbrook, IL; Westchester, IL; Oak Park, IL; Oak Brook, IL; Northlake, IL; North Riverside, IL; La Grange Park, IL…

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Gary M McCray MD SC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1195603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223942400000",
    "number": "1255512976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 ALIMA TERRACE",
            "city": "LAGRANGE PARK",
            "state": "IL",
            "postal_code": "605261331",
            "telephone_number": "708-783-5572",
            "fax_number": "708-482-4093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 ALIMA TERRACE",
            "city": "LAGRANGE PARK",
            "state": "IL",
            "postal_code": "605261331",
            "telephone_number": "708-783-5572",
            "fax_number": "708-482-4093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY M MCCRAY MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-21",
        "last_updated": "2008-10-14",
        "status": "A",
        "authorized_official_last_name": "MCCRAY",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "MYLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-783-5572",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036-064789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "039-064789",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrange Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.