Active NPI
Thomas Gray, C.R.N.A.
- Certified Registered Nurse Anesthetist
- Mattoon, IL
National Provider Identifier
1619069507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 209-000882
- Practice address
- 1000 Health Center Drive
Anesthesiology Department
Mattoon, IL 61938 - Phone
- (217) 258-2440
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 209-000882 | IL | Primary |
Addresses
Primary practice location
1000 Health Center Drive
Anesthesiology Department
Mattoon, IL 61938
Mailing address
1000 Health Center Drive
Anesthesiology Department
Mattoon, IL 61938
Phone (217) 258-2440
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)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209-000882 | IL | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303689600000",
"number": "1619069507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 HEALTH CENTER DRIVE",
"address_2": "ANESTHESIOLOGY DEPARTMENT",
"city": "MATTOON",
"state": "IL",
"postal_code": "61938",
"telephone_number": "217-258-2440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 HEALTH CENTER DRIVE",
"address_2": "ANESTHESIOLOGY DEPARTMENT",
"city": "MATTOON",
"state": "IL",
"postal_code": "61938",
"telephone_number": "217-258-2440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "THOMAS",
"credential": "C.R.N.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2011-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "IL",
"license": "209-000882",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mattoon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.