NPIMap

Individual provider Active NPI

Charles Richard Gray, PA

  • Medical Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1316970163
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA.0002579 Issued in CO
Practice address
3207 N Academy Blvd Ste 3500
Colorado Springs, CO 80917-5100
Phone
(719) 632-5700
NPI assigned
Jul 7, 2006
Last updated
Jul 12, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2003002307 MO
Medical Physician Assistant 363AM0700X PA.0002579 CO Primary

Addresses

Primary practice location

3207 N Academy Blvd Ste 3500
Colorado Springs, CO 80917-5100

Mailing address

4790 Farthing Drive
Colorado Springs, CO 80906
Phone (719) 963-7579

Other identifiers 2

IdentifierTypeStateIssuer
523191OtherMOHEALTHLINK
173190OtherMOBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080307000120 CO Practitioner - Physician Assistant 2567566573 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Alpine Medical Group Colorado PLLCGroup PAC ID 1759743347, 101 clinicians
Flagship Medical GroupGroup PAC ID 4688050263, 6 clinicians

Practice addresses (Care Compare)

Denver, CO 80202
Phone (720) 728-5170

3210 N Academy Blvd
Suite 1
Colorado Springs, CO 80917-5158
Phone (719) 733-3131

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2003002307MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Peak Vista Community Health Centers CurrentSince Jan 11, 2016 Accepting new patients
Peak Vista Community Health Centers CurrentSince Jan 11, 2016 Accepting new patients
Deatrice L Kellogg MD Past Accepting new patients
PC Associates LLC Past Accepting new patients
Front Range Emergency Specialists, PC Past Accepting new patients
Integrity Urgent Care, P.C. Past Accepting new patients

Locations

1400 E Boulder St
Colorado Springs, CO 80909
Phone (719) 365-5120

3205 N Academy Blvd
Ste 130
Colorado Springs, CO 80917
Phone (719) 344-6873

Organizations & group practices 8

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1316970163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4790 FARTHING DRIVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80906",
            "telephone_number": "719-963-7579",
            "fax_number": "719-538-2961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3207 N ACADEMY BLVD STE 3500",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175100",
            "telephone_number": "719-632-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "CHARLES",
        "middle_name": "RICHARD",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2003002307",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0002579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "523191",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "173190",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.