Active NPI
Neenah Grade, PA-C
- Physician Assistant
- San Diego, CA
National Provider Identifier
1063865061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 53586
- Practice address
- 4125 Sorrento Valley Blvd Ste a
San Diego, CA 92121-1423 - Phone
- (858) 794-9192
- NPI assigned
- Jul 14, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 53586 | CA | Primary |
Addresses
Primary practice location
4125 Sorrento Valley Blvd Ste a
San Diego, CA 92121-1423
Mailing address
4125 Sorrento Valley Blvd Ste a
San Diego, CA 92121-1423
Phone (858) 794-9192
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 53586 | Other | CA | STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 3
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.
-
- Medical Specialty Clinic/Center
- San Diego, CA
- NPI 1710315056
-
dba Pain Consultants of San Diego
- Pain Medicine Physician
- Chula Vista, CA
- NPI 1700258597
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518048000000",
"number": "1063865061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4125 SORRENTO VALLEY BLVD STE A",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921211423",
"telephone_number": "858-794-9192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4125 SORRENTO VALLEY BLVD STE A",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921211423",
"telephone_number": "858-794-9192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRADE",
"first_name": "NEENAH",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-14",
"last_updated": "2018-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "53586",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "53586",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.