Individual provider Active NPI

Elizabeth Rose Gray, CRNP

  • Pediatric Nurse Practitioner
  • Huntsville, AL
National Provider Identifier
1972104479
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
1-146153 Issued in AL
Practice address
101 Sivley Rd SW
Huntsville, AL 35801-4470
Phone
(256) 265-7677
Fax
(256) 265-7677
NPI assigned
Nov 3, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Pediatric Nurse Practitioner 363LP0222X 1-146153 AL
Pediatric Nurse Practitioner 363LP0200X 1-146153 AL Primary

Addresses

Primary practice location

101 Sivley Rd SW
Huntsville, AL 35801-4470

Mailing address

112 Oakside Cir NW
Madison, AL 35757-4201
Phone (334) 718-9588

Other names 1

  • Elizabeth Rose Ferguson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210216000457 AL Practitioner - Nurse Practitioner 7315352812 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1-146153ALMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Group CurrentSince Dec 1, 2020 Accepting new patients

Locations

101 Sivley Rd SW
Huntsville, AL 35801
Phone (256) 265-9870

245 Governors Dr SE
Huntsville, AL 35801
Phone (256) 265-7673

Organizations & group practices 1

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": "1604361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1972104479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 OAKSIDE CIR NW",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357574201",
            "telephone_number": "334-718-9588",
            "fax_number": "256-265-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SIVLEY RD SW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358014470",
            "telephone_number": "256-265-7677",
            "fax_number": "256-265-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "ELIZABETH",
        "middle_name": "ROSE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-03",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0222X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics, Critical Care",
            "state": "AL",
            "license": "1-146153",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AL",
            "license": "1-146153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "FERGUSON",
            "middle_name": "ROSE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Huntsville, AL

Sources for this page

Verify at the official NPI Registry.