Individual provider Active NPI

Grace Bazan Nelson, M.D.

  • Pediatric Endocrinology Physician
  • Memphis, TN
National Provider Identifier
1053721050
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X
License
54820 Issued in TN
Practice address
51 N Dunlap St FL 3
Memphis, TN 38105-4625
Phone
(901) 287-7337
NPI assigned
Apr 30, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Endocrinology Physician 2080P0205X 54820 TN Primary

Addresses

Primary practice location

51 N Dunlap St FL 3
Memphis, TN 38105-4625

Mailing address

49 N Dunlap St FL 1
Memphis, TN 38103-2802

Other practice location 1

University Of Tennessee
910 Madison Avenue Suite 1031
Memphis, TN 38163-0001
Phone (901) 448-7635

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20160920000283 TN Practitioner - Emergency Medicine 1254559594 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Emergency Specialists, PC Pediatric Emergency Medicine CurrentSince Sep 8, 2016 Accepting new patients

Locations

5885 Airline Rd
Unit 1011
Arlington, TN 38002

848 Adams Ave
Memphis, TN 38103
Phone (901) 287-5437

50 N Dunlap St
Fl 6
Memphis, TN 38103
Phone (901) 287-5265

7691 Poplar Ave
Memphis, TN 38138
Phone (901) 516-1290

Interoperability endpoints

  • Direct secure messaging: gnelson26374@mlh.direct-ci.com

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": "1398816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595289600000",
    "number": "1053721050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 N DUNLAP ST FL 1",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381032802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 N DUNLAP ST FL 3",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381054625",
            "telephone_number": "901-287-7337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "University Of Tennessee",
            "address_2": "910 Madison Avenue Suite 1031",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381630001",
            "country_code": "US",
            "telephone_number": "901-448-7635",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "GRACE",
        "middle_name": "BAZAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-30",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "TN",
            "license": "54820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.