Jacqueline J Gray, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

35075835 Issued in OH

Practice address

2300 Hospital Dr Ste 420
Bossier City, LA 71111-2166

Phone

(318) 212-7880

NPI assigned

Aug 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in LA

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

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.

• David Raines Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Shreveport, LA
  • NPI 1215933254
  Medicare reassignment NPD
• David Raines Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Shreveport, LA
  • NPI 1205721487
  NPD
• Childrens Medical Center Inc

  • Pediatrics Physician
  • Middletown, OH
  • NPI 1093919177
  NPD (past)

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756425600000",
    "number": "1346354297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 CURTISS RD STE 100",
            "city": "BARKSDALE AFB",
            "state": "LA",
            "postal_code": "711102425",
            "telephone_number": "318-456-6555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 HOSPITAL DR STE 420",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112166",
            "telephone_number": "318-212-7880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "331 N Breiel Blvd",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "OH",
            "postal_code": "45042",
            "country_code": "US",
            "telephone_number": "513-424-1856",
            "fax_number": "513-424-1850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAY",
        "first_name": "JACQUELINE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-18",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35075835",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "301878",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2489258",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Pamela Goode
• Morgan E Goodwin, DPT
• James Sanders Graf, DMD MS
• Grandir Counseling and Restoration LLC
• Janelle Lavon Grant
• Jonathan Simon Gray, MD
• Carolyn Grayson
• Jonathan Andrew Green
• Patricia Green
• Monica Greene, DHA, RN, BSN, MLT

• Pediatrics Physician in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2025; 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.