Active NPI
Charles Michael Grudem, MD
- Pain Medicine Physician
- Ocala, FL
National Provider Identifier
1093825150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pain Medicine Physician
- License
- ME 61060
- Practice address
- 3200 SW 34TH Ave
Suite 502
Ocala, FL 34474-7456 - Phone
- (352) 629-7011
- Fax
- (352) 629-7924
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pain Medicine Physician | 208VP0000X | ME 61060 | FL | Primary |
Addresses
Primary practice location
3200 SW 34TH Ave
Suite 502
Ocala, FL 34474-7456
Mailing address
3200 SW 34TH Ave
Suite 502
Ocala, FL 34474-7456
Phone (352) 629-7011
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17875 | Other | BCBS | |
| 720000084 | Other | FL | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME 61060 | FL | MD | Pain Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214524800000",
"number": "1093825150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 SW 34TH AVE",
"address_2": "SUITE 502",
"city": "OCALA",
"state": "FL",
"postal_code": "344747456",
"telephone_number": "352-629-7011",
"fax_number": "352-629-7924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 SW 34TH AVE",
"address_2": "SUITE 502",
"city": "OCALA",
"state": "FL",
"postal_code": "344747456",
"telephone_number": "352-629-7011",
"fax_number": "352-629-7924"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRUDEM",
"first_name": "CHARLES",
"middle_name": "MICHAEL",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2008-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "208VP0000X",
"taxonomy_group": "",
"desc": "Pain Medicine, Pain Medicine",
"state": "FL",
"license": "ME 61060",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "17875",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "720000084",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ocala, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.