Active NPI
Jeffrey Wayne Gray, PH.D.
- Specialist
- Evansville, IN
National Provider Identifier
1366551970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 20040332
- Practice address
- 1450 Bellemeade Ave
Evansville, IN 47714-2062 - Phone
- (812) 477-0407
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 20040332 | IN | Primary |
Addresses
Primary practice location
1450 Bellemeade Ave
Evansville, IN 47714-2062
Mailing address
1450 Bellemeade Ave
Evansville, IN 47714-2062
Phone (812) 477-0407
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN, KY
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060207000228 | IN | Practitioner - Psychologist Billing Independently | 8729093141 | Practice locations: Evansville, IN |
| I20090414000452 | KY | Practitioner - Psychologist Billing Independently | 8729093141 | Practice locations: Owensboro, KY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1154 Washington SQ
Evansville, IN 47715-5982
1154 Washington SQ
Evansville, IN 47715-6809
Phone (812) 477-0407
1154 Washington Square
Evansville, IN 47715-5982
1154 Washington Square
Evansville, IN 47715-6809
1301 Pleasant Valley Rd
FL 5
Owensboro, KY 42303-9774
Phone (812) 477-0407
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20040332 | IN | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366551970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1450 BELLEMEADE AVE",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477142062",
"telephone_number": "812-477-0407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1450 BELLEMEADE AVE",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477142062",
"telephone_number": "812-477-0407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "JEFFREY",
"middle_name": "WAYNE",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IN",
"license": "20040332",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.