NPIMap

Individual provider Active NPI

Jennifer Gray, MD

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1700927902
Registry record updated Nov 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M7051 Issued in ID
Practice address
6533 W Emerald Street
Boise, ID 83704
Phone
(208) 302-5200
Fax
(208) 302-5225
NPI assigned
Feb 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M7051 ID Primary

Addresses

Primary practice location

6533 W Emerald Street
Boise, ID 83704

Mailing address

3340 E Goldstone Way
Meridian, ID 83642
Phone (208) 302-5200

Other identifiers 2

IdentifierTypeStateIssuer
080186325OtherIDRRMCR
003701700MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100908000766 ID Practitioner - Family Practice 6406816982 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic - McCall LLCGroup PAC ID 7618127994, 44 clinicians
Saint Alphonsus Regional Medical Center IncGroup PAC ID 3476462359, 672 clinicians

Practice addresses (Care Compare)

200 Forest St
McCall, ID 83638-5256
Phone (208) 630-2470

209 Forest St
McCall, ID 83638-5256
Phone (208) 637-1776

211 Forest St
McCall, ID 83638-5256
Phone (208) 634-2225

3025 W Cherry LN
Meridian, ID 83642-8531

6533 W Emerald St
Boise, ID 83704-8737
Phone (208) 302-5200

Hospital & facility affiliations

  • St Luke'S McCall Hospital, McCall, ID, CCN 131312
  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M7051IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Dec 10, 2018 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc Family Medicine CurrentSince Dec 10, 2018 Accepting new patients
St Lukes Clinic - McCall LLC Family Medicine CurrentSince Oct 1, 2012 Accepting new patients
Payette Lakes Medical Clinic, PA Past Accepting new patients
St Lukes McCall, LTD Family Medicine Past Accepting new patients
Valley Family Health Care, Inc Family Medicine Past Accepting new patients

Locations

6533 W Emerald St
Boise, ID 83704
Phone (208) 302-5200

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

1000 State St
McCall, ID 83638
Phone (208) 634-2221

200 W Forest St
McCall, ID 83638
Phone (208) 630-2470

211 W Forest St
McCall, ID 83638
Phone (208) 467-7546

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

Interoperability endpoints

  • Direct secure messaging: jgray1564179@direct.trinity-health.org
  • Direct secure messaging: jgray17351@direct.slhs.org

Organizations & group practices 7

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 6

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": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541548800000",
    "number": "1700927902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-302-5200",
            "fax_number": "208-302-5225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6533 W EMERALD STREET",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83704",
            "telephone_number": "208-302-5200",
            "fax_number": "208-302-5225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "JENNIFER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-09",
        "last_updated": "2018-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M7051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMCR",
            "identifier": "080186325",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003701700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.