Active NPI
Vanessa Graham, PA-C
- Physician Assistant
- Mason, OH
National Provider Identifier
1104433309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 50.006496RX
- Practice address
- 5240 Socialville Foster Rd
Mason, OH 45040-9302 - Phone
- (513) 231-5698
- NPI assigned
- Sep 30, 2020
- 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 | 50.006496RX | OH | Primary |
Addresses
Primary practice location
5240 Socialville Foster Rd
Mason, OH 45040-9302
Mailing address
87 N Glen Oak Dr
Springboro, OH 45066-8133
Other practice location 1
4755 Highway 31 E
Clarksville, IN 47129-9220
Phone (812) 282-4037
Other practice location 2
87 N Glen Oak Dr
Springboro, OH 45066-8133
Phone (419) 310-7385
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50.006496RX | OH | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Ohio Five Medical Group, PLLC | Past | Accepting new patients | |
| Low-T Physicians Services PLLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Urology Physician
- Friendswood, TX
- NPI 1477992717
-
- Primary Care Clinic/Center
- Houston, TX
- NPI 1710643101
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752710400000",
"number": "1104433309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "87 N GLEN OAK DR",
"city": "SPRINGBORO",
"state": "OH",
"postal_code": "450668133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5240 SOCIALVILLE FOSTER RD",
"city": "MASON",
"state": "OH",
"postal_code": "450409302",
"telephone_number": "513-231-5698"
}
],
"practiceLocations": [
{
"address_1": "4755 Highway 31 E",
"address_purpose": "LOCATION",
"city": "Clarksville",
"state": "IN",
"postal_code": "471299220",
"country_code": "US",
"telephone_number": "812-282-4037",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "87 N Glen Oak Dr",
"address_purpose": "LOCATION",
"city": "Springboro",
"state": "OH",
"postal_code": "450668133",
"country_code": "US",
"telephone_number": "419-310-7385",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GRAHAM",
"first_name": "VANESSA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-30",
"last_updated": "2025-07-17",
"certification_date": "2025-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OH",
"license": "50.006496RX",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mason, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.