Susan Wambui Gray

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

11016895 Issued in FL

Practice address

14055 Budworth Cir
Orlando, FL 32832-6123

Phone

(770) 912-8905

NPI assigned

May 13, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lifestream Behavioral Center IncGroup PAC ID 7012992720, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Lifestream Behavioral Center Inc

  • Psychiatric Hospital
  • Leesburg, FL
  • NPI 1902802002

  FL

  Medicare reassignment Care Compare group NPD
• Virtual Inpatient Psychiatry Physicians Behavioral Network LLC

  • Psychiatry Physician
  • Deland, FL
  • NPI 1801385521

  FL

  Medicare reassignment NPD
• Lifestream Behavioral Center Inc

  • Primary Care Clinic/Center
  • Leesburg, FL
  • NPI 1659613776
  NPD

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

{
    "created_epoch": "1242172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1306070701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14055 BUDWORTH CIR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328326123",
            "telephone_number": "770-912-8905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14055 BUDWORTH CIR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328326123",
            "telephone_number": "770-912-8905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "SUSAN",
        "middle_name": "WAMBUI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-13",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "GA",
            "license": "LPN074267",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "11016895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Gray, PT
• Payton Gray
• Rea Gray
• Richard Louis Gray, M.D.
• Stacey Ellen Gray, MSW, RCSW
• Viviene Verona Gray, FNP-C, PMHNP-BC
• Tennesha Samanta Grayarmstrong, FNP-BC
• Morgan Graybill, FNP-C
• Debra Laing Grayman, M.D.
• Ashley Grays

• All providers in Orlando, FL
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2021; 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.