Individual provider Active NPI

Terri D Gray, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Vernon Hills, IL
National Provider Identifier
1629840046
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
209.028479 Issued in IL
Practice address
175 E Hawthorn Pkwy Ste 235
Vernon Hills, IL 60061-1454
Phone
(847) 865-4127
NPI assigned
Oct 30, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209.028479 IL Primary

Addresses

Primary practice location

175 E Hawthorn Pkwy Ste 235
Vernon Hills, IL 60061-1454

Mailing address

175 E Hawthorn Pkwy Ste 235
Vernon Hills, IL 60061-1454
Phone (847) 865-4125

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231115002075 IL Practitioner - Nurse Practitioner 7618324435 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

175 E Hawthorn Pkwy
Suite 235
Vernon Hills, IL 60061-1454
Phone (888) 428-7890

Merit-based Incentive Payment System (MIPS)

Final score
97.25 of 100Reported as group
Quality
80.59
Promoting interoperability
100
Improvement activities
40
Cost
76.91

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.028479ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rodasi LLC Psychiatric/Mental Health CurrentSince Jan 10, 2025 Accepting new patients
Edgewood Clinical Services, P.C. Psychiatric/Mental Health CurrentSince Dec 1, 2024 Accepting new patients
Psychology Specialists LTD Past Accepting new patients

Locations

808 S Eldorado Rd
Ste 102
Bloomington, IL 61704
Phone (309) 212-6007

2500 W Higgins Rd
Ste 105
Hoffman Estates, IL 60169
Phone (773) 904-0094

684 S Barrington Rd
Streamwood, IL 60107
Phone (630) 883-0815

175 E Hawthorne Pkwy
Ste 235
Vernon Hills, IL 60061
Phone (847) 865-4125

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.terrigray@146897.advancedmd-direct.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1698624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1629840046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 E HAWTHORN PKWY STE 235",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611454",
            "telephone_number": "847-865-4125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 E HAWTHORN PKWY STE 235",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611454",
            "telephone_number": "847-865-4127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "TERRI",
        "middle_name": "D",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-30",
        "last_updated": "2024-12-04",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209.028479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vernon Hills, IL

Sources for this page

Verify at the official NPI Registry.