Blake Ashley Gray, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

125085065 Issued in IL

Practice address

400 N 9TH St # 4a
Springfield, IL 62702-5310

Phone

(217) 545-8000

NPI assigned

Nov 4, 2024

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

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: blakegray@siusm.allscriptsdirect.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.

• Board of Trustees of Southern Illinois University

  dba Carbondale Care A Van

  • Rural Health Clinic/Center
  • Carbondale, IL
  • NPI 1215978127
  NPD

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

{
    "created_epoch": "1730678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1285457606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N 9TH ST # 4A",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025310",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-4779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N 9TH ST # 4A",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025310",
            "telephone_number": "217-545-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "BLAKE",
        "middle_name": "ASHLEY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-04",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125085065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Autumn Graves
• Christopher Mark Graves, MD
• Mark W Graves, MD
• Shannon Nicole Graves, APRN
• Gray Therapy Group, PLLC
• Marissa Gray, LCSW
• Michael R Gray
• Great Health Medical Afil, P.C.
• Great Lakes Caring Hospice C Il, LLC (Elara Caring VII)
• Mark D. Greatting, M.D.

• Pediatrics Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.