Grossman Medical Rejuvenation Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

GROSSMAN MEDICAL REJUVENATION INC

Practice address

4440 Von Karman Ave Ste 202
Newport Beach, CA 92660-2011

Phone

(877) 258-6331

Fax

(718) 362-1651

NPI assigned

May 11, 2024

Organization subpart

No

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

Authorized official

Name

Michael Grossman, MDNPI 1942367008

Title

Owner

Phone

(877) 258-6331

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dawn M McClure, NURSE PRACTITIONER

  • Primary Care Nurse Practitioner
  • Rancho Cucamonga, CA
  • NPI 1023704434
  Medicare reassignment NPD
• Alana Swift, NP

  • Nurse Practitioner
  • Cerritos, CA
  • NPI 1497399430
  Medicare reassignment NPD
• Michael Jack Grossman, M.D.

  • Family Medicine Physician
  • Lake Forest, CA
  • NPI 1942367008
  NPD Authorized official

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

{
    "created_epoch": "1715385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715385600000",
    "number": "1063260248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 CORPORATE WAY STE 2M",
            "city": "VALLEY COTTAGE",
            "state": "NY",
            "postal_code": "109892027",
            "telephone_number": "877-258-6331",
            "fax_number": "718-362-1651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4440 VON KARMAN AVE STE 202",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602011",
            "telephone_number": "877-258-6331",
            "fax_number": "718-362-1651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GROSSMAN MEDICAL REJUVENATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-11",
        "last_updated": "2024-05-11",
        "certification_date": "2024-05-11",
        "status": "A",
        "authorized_official_last_name": "GROSSMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "877-258-6331",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Airian Dawn Grisham
• Phyllis Ann Grismore
• Rebecca Groff, PTA
• Christine Lynn Groshong
• David Ryan Gross
• Barbara Robinson Grossman, PH.D.
• Jason Groth, RN
• Deborah J Grouse, MD
• Risa Groux, CN
• Linda Grove, LMFT

• Family Medicine Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.