Deetta Gray, M.D., FAAD, FRCPC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

025209 MD00035417 Issued in WA

Practice address

1515 116TH Ave NE
Ste 307
Bellevue, WA 98004-3811

Phone

(425) 999-2628

Fax

(425) 646-2965

NPI assigned

Feb 7, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Silver Falls Dermatology LLCGroup PAC ID 5890863492, 100 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dgray@frontierdermpartners.emadirect.md

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.

• Silver Falls Dermatology, LLC

  dba Frontier Dermatology

  • Dermatology Physician
  • Salem, OR
  • NPI 1134375421

  WA

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393372800000",
    "number": "1790825966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3418",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980833418",
            "telephone_number": "425-999-2628",
            "fax_number": "425-646-2965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 116TH AVE NE",
            "address_2": "STE 307",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043811",
            "telephone_number": "425-999-2628",
            "fax_number": "425-646-2965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "DEETTA",
        "credential": "M.D., FAAD, FRCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-07",
        "last_updated": "2014-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WA",
            "license": "025209 MD00035417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeanette Grant
• Melba Lazette Grant
• Sara Gratz, M.S.
• Sara Monique Gravelin, MD
• Alivia Gray
• Isiah Gray
• Jamesyn Gray
• Jo Gray, ARNP
• Joshua Gray
• Lauren Anne Gray, LMFT

• Dermatology Physician in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Dermatology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.