Graham Pediatric Clinic, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

GRAHAM PEDIATRIC CLINIC, LLC

Practice address

706 Main St Ste 2a
Klamath Falls, OR 97601-6010

Phone

(541) 591-0877

Fax

(888) 519-9117

NPI assigned

Aug 1, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Tracy Graham, MDNPI 1831278589

Title

Physician

Phone

(541) 851-7350

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tracy Warwick Graham, MD

  • Pediatrics Physician
  • Klamath Falls, OR
  • NPI 1831278589
  NPD Authorized official
• Brea Elise Frost, MS, PA-C

  • Medical Physician Assistant
  • Klamath Falls, OR
  • NPI 1619379013
  NPD (past)
• Samantha Viola Dougherty Peters, PA-C

  • Physician Assistant
  • Klamath Falls, OR
  • NPI 1538674924
  NPD (past)

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

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1174250104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 MAIN ST STE 2A",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976016010",
            "telephone_number": "541-851-7350",
            "fax_number": "541-851-7351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 MAIN ST STE 2A",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976016010",
            "telephone_number": "541-591-0877",
            "fax_number": "888-519-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAHAM PEDIATRIC CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-01",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "541-851-7350",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laurie Kay Goolsby, RPH
• Meghan Rae Gorbett, CMA
• Joshua Vaughn Gossman, M.S.
• Tiffiny Michelle Gour
• Grace William Health Systems
• Barbara Graham
• Teresa Roleen Graham, MD
• Tracy Warwick Graham, MD
• Elise Rose Granath, PA-C, MPH
• Mariah Grau

• Pediatrics Physician in Klamath Falls, OR
• Providers in Klamath Falls, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.