Individual provider Active NPI

Cynthia Lorraine Gray, NP

  • Family Nurse Practitioner
  • Kettering, OH
National Provider Identifier
1649870486
Registry record updated Dec 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN.CNP.0027943 Issued in OH
Practice address
3700 Southern Blvd Ste 401
Kettering, OH 45429-1265
Phone
(855) 500-2873
Fax
(937) 281-3913
NPI assigned
Oct 30, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN.CNP.0027943 OH Primary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X APRN.CNP.0027943 OH

Addresses

Primary practice location

3700 Southern Blvd Ste 401
Kettering, OH 45429-1265

Mailing address

3700 Southen Blvd
401
Kettering, OH 45429

Other identifiers 1

IdentifierTypeStateIssuer
0424845MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/
Direct Messaging Address cgray378495@direct.ketteringhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20201123001996 OH Practitioner - Nurse Practitioner 8921419987 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Cincinnati College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

3700 Southern Blvd
Suite 401
Kettering, OH 45429-1265
Phone (855) 500-2873

Hospital & facility affiliations

  • Kettering Health Dayton Hospital, Dayton, OH, CCN 360133
  • Kettering Health Main Campus Hospital, Kettering, OH, CCN 360079
  • Soin Medical Center Hospital, Beaver Creek, OH, CCN 360360
  • Kettering Health Miamisburg Hospital, Miamisburg, OH, CCN 360239

Merit-based Incentive Payment System (MIPS)

Final score
81.34 of 100Reported as group
Quality
63.67
Promoting interoperability
100
Improvement activities
40
Cost
74.14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN.CNP.0027943OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kettering Independent Medical Group Inc Single Specialty CurrentSince Feb 1, 2023 Accepting new patients
Lima Memorial Joint Operating Company Single Specialty Past Accepting new patients

Locations

3535 Pentagon Blvd
Ste 400
Beavercreek, OH 45431
Phone (855) 500-2873

1010 Cereal Ave
Ste 300
Hamilton, OH 45013
Phone (513) 751-2145

3700 Southern Blvd
Kettering, OH 45429
Phone (855) 500-2873

3700 Southern Blvd
Ste 401
Kettering, OH 45429
Phone (855) 500-2873

4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910

3700 Southern Blvd
#401
Kettering, OH 45429

2300 N Limestone St
Ste 120
Springfield, OH 45503
Phone (866) 224-9472

600 W Main St
Ste 130
Troy, OH 45373
Phone (855) 500-2873

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 and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1604016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1649870486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 SOUTHEN BLVD",
            "address_2": "401",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "45429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 SOUTHERN BLVD STE 401",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291265",
            "telephone_number": "855-500-2873",
            "fax_number": "937-281-3913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "CYNTHIA",
        "middle_name": "LORRAINE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-30",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.0027943",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.0027943",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0424845",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3700 Southern Blvd Ste 401",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291265",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cgray378495@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3700 Southern Blvd Ste 401",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

Verify at the official NPI Registry.