Active NPI
Jade Gray
- Student in an Organized Health Care Education/Training Program
- Dekalb, IL
National Provider Identifier
1881132090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 835 Edgebrook Dr Apt 118
Dekalb, IL 60115-1446 - Phone
- (708) 368-8223
- NPI assigned
- Feb 8, 2017
- Last updated
- Feb 8, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
835 Edgebrook Dr Apt 118
Dekalb, IL 60115-1446
Mailing address
835 Edgebrook Dr Apt 118
Dekalb, IL 60115-1446
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486512000000",
"number": "1881132090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "835 EDGEBROOK DR APT 118",
"city": "DEKALB",
"state": "IL",
"postal_code": "601151446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "835 EDGEBROOK DR APT 118",
"city": "DEKALB",
"state": "IL",
"postal_code": "601151446",
"telephone_number": "708-368-8223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "JADE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-02-08",
"last_updated": "2017-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dekalb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.