NPIMap

Individual provider Active NPI

Grant Tyler Whittaker, M.D.

  • Gastroenterology Physician
  • Fernandina Beach, FL
National Provider Identifier
1073710992
Registry record updated Aug 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
ME105816 Issued in FL
Practice address
1348 South 18TH Street
Suite 100
Fernandina Beach, FL 32034-4755
Phone
(904) 261-0879
Fax
(904) 277-7054
NPI assigned
Jul 3, 2007
Last updated
Aug 27, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD 30868 AL
Internal Medicine Physician 207R00000X ME 105816 FL
Gastroenterology Physician 207RG0100X ME105816 FL Primary

Addresses

Primary practice location

1348 South 18TH Street
Suite 100
Fernandina Beach, FL 32034-4755

Mailing address

4800 Belfort Rd
Jacksonville, FL 32256-6004

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140820001247 FL Practitioner - Gastroenterology 4587801154 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
University of South Florida College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Borland Groover Clinic, PAGroup PAC ID 6507761301, 128 clinicians

Practice addresses (Care Compare)

4800 Belfort Rd
Jacksonville, FL 32256-6004
Phone (904) 398-7205

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.94 of 100Reported as group
Quality
69.69
Promoting interoperability
89
Improvement activities
40
Cost
69.28

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy247
Upper gastrointestinal (GI) endoscopy for acid reflux190

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD 30868ALMDInternal Medicine Physician
ME 105816FLMDInternal Medicine Physician
ME105816FLMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Borland Groover Clinic, PA Gastroenterology CurrentSince Jul 1, 2014 Accepting new patients

Locations

1340 S 18th St
Ste 204
Fernandina Beach, FL 32034
Phone (904) 261-0643

1348 S 18th St
Ste 100
Fernandina Beach, FL 32034
Phone (904) 261-0878

4800 Belfort Rd
Jacksonville, FL 32256
Phone (904) 307-2084

836 Prudential Dr
Ste 801
Jacksonville, FL 32207
Phone (904) 288-0433

462626 State Road 200
Ste 300
Yulee, FL 32097
Phone (904) 364-1626

Interoperability endpoints

  • Direct secure messaging: grant.whittaker.p1@direct.bgclinic.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409097600000",
    "number": "1073710992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 BELFORT RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1348 SOUTH 18TH STREET",
            "address_2": "SUITE 100",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320344755",
            "telephone_number": "904-261-0879",
            "fax_number": "904-277-7054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITTAKER",
        "first_name": "GRANT",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-03",
        "last_updated": "2014-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "MD 30868",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME 105816",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "FL",
            "license": "ME105816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fernandina Beach, FL

Sources for this page

Verify at the official NPI Registry.