Individual provider Active NPI

Deanne Elizabeth Grayson, D.O.

  • Psychiatry Physician
  • Saint Augustine, FL
National Provider Identifier
1851685135
Registry record updated Sep 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
OS16287 Issued in FL
Practice address
1100 Plantation Island Dr S
Saint Augustine, FL 32080-5173
Phone
(904) 824-7733
NPI assigned
Jun 5, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X DOS-1534 HI
General Practice Physician 208D00000X DOS-1534 HI
Psychiatry Physician 2084P0800X OS16287 FL Primary

Addresses

Primary practice location

1100 Plantation Island Dr S
Saint Augustine, FL 32080-5173

Mailing address

1100 Plantation Island Dr S Ste 110
Saint Augustine, FL 32080-5173
Phone (904) 824-7733

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20210319001382 FL Practitioner - Geriatric Psychiatry 5991037293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Psychiatry
Education
Lincoln Mem Univ, Debusk Col of Osteopathic Med, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1100 Plantation Island Dr S
Suite 110
St Augustine, FL 32080-5173
Phone (904) 824-7733

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS16287FLMDPsychiatry Physician
DOS-1534HIMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care of North Carolina, P.C. CurrentSince Jun 1, 2024 Accepting new patients
Optum Behavioral Care of North Carolina, PC CurrentSince Jun 1, 2024 Accepting new patients

Locations

1100 Plantation Island Dr S
Ste 110
Saint Augustine, FL 32080
Phone (904) 217-4259

1090 Tamiami Trl
Sarasota, FL 34236
Phone 94136308782005

4700 N Habana Ave
Ste 703
Tampa, FL 33614
Phone (813) 678-2373

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.

NPI Registry JSON

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

{
    "created_epoch": "1307232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1851685135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 PLANTATION ISLAND DR S STE 110",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320805173",
            "telephone_number": "904-824-7733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 PLANTATION ISLAND DR S",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320805173",
            "telephone_number": "904-824-7733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAYSON",
        "first_name": "DEANNE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-05",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "HI",
            "license": "DOS-1534",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "HI",
            "license": "DOS-1534",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "OS16287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Augustine, FL

Sources for this page

Verify at the official NPI Registry.