NPIMap

Individual provider Active NPI

Carly Gray, NP

  • Adult Health Nurse Practitioner
  • La Grande, OR
National Provider Identifier
1962804641
Registry record updated Jul 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
201503486NP-PP Issued in OR
Practice address
506 4TH St
La Grande, OR 97850
Phone
(541) 663-3138
Fax
(541) 975-5120
NPI assigned
Sep 24, 2014
Sex
Female
Sole proprietor
Yes

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 18

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

View all 18

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rutland Hospital, Inc. 186 clinicians

Practice addresses (Care Compare)

160 Allen St
Rutland, VT 05701-4560
Phone (802) 775-7111

Hospital & facility affiliations

  • Rutland Regional Medical Center Hospital, Rutland, VT, CCN 470005
  • Porter Hospital Inc Hospital, Middlebury, VT, CCN 471307

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
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
I20250826000089 VT Practitioner - Nurse Practitioner 6204149867 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NP-1503AIDMDAdult Health Nurse Practitioner
201503486NP-PPORMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rutland Hospital, Inc. CurrentSince Aug 1, 2025 Accepting new patients
Rutland Hospital, Inc. CurrentSince Aug 1, 2025 Accepting new patients
Rutland Hospital, Inc Past Accepting new patients

Locations

160 Allen St
Rutland, VT 05701

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/6f43d0e7-6ff2-489b-abdc-44e8a5e0ca0a/

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X NP-1503A ID
Adult Health Nurse Practitioner 363LA2200X 201503486NP-PP OR Primary

Addresses

NPPES NPI Registry

Primary practice location

506 4TH St
La Grande, OR 97850

Mailing address

PO Box 3290
La Grande, OR 97850-7290
Phone (541) 963-1967

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 24, 2018.

{
    "created_epoch": "1411516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532390400000",
    "number": "1962804641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3290",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978507290",
            "telephone_number": "541-963-1967",
            "fax_number": "541-963-1837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 4TH ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "97850",
            "telephone_number": "541-663-3138",
            "fax_number": "541-975-5120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "CARLY",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-24",
        "last_updated": "2018-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "ID",
            "license": "NP-1503A",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OR",
            "license": "201503486NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grande, OR

Sources for this page

Verify at the official NPI Registry.