Bennett G Gray IV, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

036067155 Issued in IL

Practice address

9821 Irvine Center Dr
Irvine, CA 92618-4307

Phone

(800) 741-7629

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL, MD, DC3 enrollments

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 3

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Medstar Medical Group II LLC

  • General Practice Physician
  • Baltimore, MD
  • NPI 1184046187

  DC, IL

  Medicare reassignment NPD
• Medstar Medical Group Radiology, LLC

  • Diagnostic Radiology Physician
  • Washington, DC
  • NPI 1326450156

  IL, MD

  Medicare reassignment NPD
• Physician Imaging of Washington Hospital Center LLC

  dba MedStar Radiology Network at Barlow

  • Radiology Clinic/Center
  • Chevy Chase, MD
  • NPI 1831385871

  DC, Diagnostic Radiology

  Medicare reassignment NPD
• Medstar Medical Group II LLC

  • Internal Medicine Physician
  • Washington, DC
  • NPI 1376887844
  NPD
• Physician Imaging of Washington Hospital Center, LLC

  dba Medstar Radiology Network at Timonium

  • Radiology Clinic/Center
  • Timonium, MD
  • NPI 1790211811

  Diagnostic Radiology

  NPD
• Advanced Diagnostic Imaging LTD

  • Diagnostic Radiology Physician
  • Belleville, IL
  • NPI 1235174764
  NPD (past)
• Great Plains Imaging, LLC

  • Diagnostic Radiology Physician
  • Wichita, KS
  • NPI 1629162326
  NPD (past)
• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781
  NPD (past)
• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641

  Diagnostic Radiology

  NPD (past)
• Radcare of Tennessee PC

  • Diagnostic Radiology Physician
  • Chattanooga, TN
  • NPI 1538186226
  NPD (past)
• Radiology Consultants of Mid-America, PC

  • Diagnostic Radiology Physician
  • Belleville, IL
  • NPI 1598716771
  NPD (past)
• Specialists in Medical Imaging SC

  • Diagnostic Radiology Physician
  • Olympia Fields, IL
  • NPI 1841687951
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715558400000",
    "number": "1376637132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 E SOUTHCREST CIR",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253147",
            "telephone_number": "618-659-0457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9821 IRVINE CENTER DR",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926184307",
            "telephone_number": "800-741-7629"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "77 E Southcrest Cir",
            "address_purpose": "LOCATION",
            "city": "Edwardsville",
            "state": "IL",
            "postal_code": "620253147",
            "country_code": "US",
            "telephone_number": "618-659-0457",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "310 W Losey St",
            "address_purpose": "LOCATION",
            "city": "Scott AFB",
            "state": "IL",
            "postal_code": "622255250",
            "country_code": "US",
            "telephone_number": "618-256-7411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAY",
        "first_name": "BENNETT",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036067155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200364700A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Grant
• Kyle Lawrence Gravel, M.S., BCBA
• Deborah H. Graves, OTR/L
• Nicole Graves, M.A., CCC-SLP
• Jill Gravois, LCSW
• Erika Ildiko Gray, INTERN PHARMACIST
• Jordan C. Gray, LMFT
• Rachael Louise Gray, M.S., CCC-SLP
• Shirley M Gray, PA
• Hesma Greaves-Stephens

• Diagnostic Radiology Physician in Irvine, CA
• Providers in Irvine, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; 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.