Peyton Vacala Gruber, PA-S

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1190005

Practice address

339 Railroad Ave Unit 429
North Augusta, SC 29841-3996

Phone

(912) 432-0541

NPI assigned

Sep 6, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Acs Primary Care Physicians - Southeast PC

  • Emergency Medicine Physician
  • Myrtle Beach, SC
  • NPI 1861430555

  GA

  Medicare reassignment

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

{
    "created_epoch": "1662422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1174244396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 RAILROAD AVE UNIT 429",
            "city": "NORTH AUGUSTA",
            "state": "SC",
            "postal_code": "298413996",
            "telephone_number": "912-432-0541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 RAILROAD AVE UNIT 429",
            "city": "NORTH AUGUSTA",
            "state": "SC",
            "postal_code": "298413996",
            "telephone_number": "912-432-0541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUBER",
        "first_name": "PEYTON",
        "middle_name": "VACALA",
        "credential": "PA-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-06",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": "1190005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janiya Green
• Megan Elizabeth Griffin, M.A. CF-SLP
• Makena Uyen Griffis
• Simone Grigsby
• Christy Carter Grover
• Lindsey Guilbeau
• Kacy Moses Gustafson, COTA/L
• Ivonne De Liz Guzman Martinez, RBT
• Michael Cory Hall, DMD
• Sarah Hall

• Physician Assistant in North Augusta, SC
• Providers in North Augusta, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; 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.

Verify at the official NPI Registry.