Alan J Grenke, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-854 Issued in ME

Practice address

2800 E Ajo Way
Tucson, AZ 85713-6204

Phone

(520) 874-4921

NPI assigned

Aug 5, 2006

Last updated

Jul 31, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Banner-University Medical Group

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1508809427
  NPD (past)

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248998400000",
    "number": "1073522215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2826 E 10TH ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857165209",
            "telephone_number": "520-393-8234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 E AJO WAY",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857136204",
            "telephone_number": "520-874-4921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRENKE",
        "first_name": "ALAN",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2009-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA-854",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "3748",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE AHCCCS",
            "identifier": "329420",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z121868",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul F Gregory, MD
• Susan Kathryn Gregory, LMSW
• Tyler James Gregory, PT,DPT
• Lindsay Greiten, O.D.
• Denise Grenier, MSW, LCSW
• Catherine Grennell
• Steven B Gresham, MA, PHD
• Amber Nicole Greth
• Matthew Gretzer, MD
• Berneet Kaur Grewal, M.D.

• Physician Assistant in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.