Active NPI
Grover Louis Wray, LMSW
- Social Worker
- Idaho Falls, ID
National Provider Identifier
1376984054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 690
- Practice address
- 2222 Teton PLZ Ste 2
Idaho Falls, ID 83404-6485 - Phone
- (208) 522-4026
- NPI assigned
- Jul 10, 2013
- Last updated
- Jul 10, 2013
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 690 | ID | Primary |
Addresses
Primary practice location
2222 Teton PLZ Ste 2
Idaho Falls, ID 83404-6485
Mailing address
3440 E 200 N
Rigby, ID 83442-5400
Phone (208) 754-4913
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 690 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 690 | ID | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373414400000",
"number": "1376984054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3440 E 200 N",
"city": "RIGBY",
"state": "ID",
"postal_code": "834425400",
"telephone_number": "208-754-4913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2222 TETON PLZ STE 2",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834046485",
"telephone_number": "208-522-4026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WRAY",
"first_name": "GROVER",
"middle_name": "LOUIS",
"name_prefix": "Mr.",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-07-10",
"last_updated": "2013-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ID",
"license": "690",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "690",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.