Individual provider Active NPI

Tommi Michelle Gray Stanley, M.S. CCC-A

  • Audiologist
  • North Myrtle Beach, SC
National Provider Identifier
1639336332
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
3410 Issued in SC
Practice address
1016 2ND Ave N Ste 102
North Myrtle Beach, SC 29582-3287
Phone
(843) 732-6090
Fax
(843) 491-3573
NPI assigned
May 20, 2008
Last updated
Jan 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 3410 SC Primary

Addresses

Primary practice location

1016 2ND Ave N Ste 102
North Myrtle Beach, SC 29582-3287

Mailing address

1016 2ND Ave N Ste 102
North Myrtle Beach, SC 29582-3287
Phone (843) 732-6090

Other identifiers 1

IdentifierTypeStateIssuer
SA1158MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110321000796 SC Practitioner - Qualified Audiologist 8729261219 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
West Virginia University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1016 2ND Ave N
Suite 102
North Myrtle Beach, SC 29582-3287
Phone (843) 732-6090

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Strand Hearing, LLC Audiologist CurrentSince Jun 22, 2015 Accepting new patients
Carolina Speech and Hearing, Inc. Audiologist PastSince Nov 1, 2022 Accepting new patients

Locations

1016 2nd Ave N
Ste 102
North Myrtle Beach, SC 29582
Phone (843) 732-6090

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1639336332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 2ND AVE N STE 102",
            "city": "NORTH MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295823287",
            "telephone_number": "843-732-6090",
            "fax_number": "843-491-3573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 2ND AVE N STE 102",
            "city": "NORTH MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295823287",
            "telephone_number": "843-732-6090",
            "fax_number": "843-491-3573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY STANLEY",
        "first_name": "TOMMI",
        "middle_name": "MICHELLE",
        "credential": "M.S. CCC-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-20",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "SC",
            "license": "3410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SA1158",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; 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.

Verify at the official NPI Registry.