Jonathan Bruce Grayson, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS003671L Issued in PA

Practice address

4 E Holly St Ste 219
Pasadena, CA 91103-4519

Phone

(626) 639-3994

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2018 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1346350378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 CORDOVA ST UNIT 304",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052749",
            "telephone_number": "610-416-0122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 E HOLLY ST STE 219",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911034519",
            "telephone_number": "626-639-3994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAYSON",
        "first_name": "JONATHAN",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS003671L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "0049372000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "461698000",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcus Graves
• Catherine Lynn Gray, PSY.D.
• Megan A Gray, PSY.D.
• Sharon Kay Gray, CCC-SLP
• Rachel Grayczyk
• Great Company (986 Pharmacy #8032)
• Nicholas Withrow Greco, M.D.
• Roberta Diane Green PH.D., MSW, PH.D.
• Berzette Green
• Desiree Green

• Psychologist in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Psychologist in California

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

Verify at the official NPI Registry.