Individual provider Active NPI

Charles P Bray, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1336120575
Registry record updated Mar 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601001995 Issued in MI
Practice address
2680 Leonard St NE Ste 3
Grand Rapids, MI 49525-6901
Phone
(616) 317-7246
Fax
(616) 920-6540
NPI assigned
Nov 7, 2005
Last updated
Mar 20, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601001995 MI Primary

Addresses

Primary practice location

2680 Leonard St NE Ste 3
Grand Rapids, MI 49525-6901

Mailing address

5555 Glenwood Hills Pkwy SE Ste 2
Grand Rapids, MI 49512-2091
Phone (616) 940-2662

Other identifiers 1

IdentifierTypeStateIssuer
P70026934OtherRAILROAD MEDICARE

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20070713000722 MI Practitioner - Physician Assistant 9638279011 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Haven Spine and Pain Center PLLCGroup PAC ID 9537576129, 7 clinicians

Practice addresses (Care Compare)

2680 Leonard St NE
Suite 3
Grand Rapids, MI 49525-6902
Phone (616) 364-4200

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
West Michigan Heart Physician Assistant Past Accepting new patients

Organizations & group practices 2

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 5

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

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710892800000",
    "number": "1336120575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 GLENWOOD HILLS PKWY SE STE 2",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495122091",
            "telephone_number": "616-940-2662",
            "fax_number": "616-940-1965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 LEONARD ST NE STE 3",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495256901",
            "telephone_number": "616-317-7246",
            "fax_number": "616-920-6540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAY",
        "first_name": "CHARLES",
        "middle_name": "P",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601001995",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P70026934",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.