NPIMap

Organization Active NPI

Grady D. Gafford MD PC

  • Ophthalmology Physician
  • Wellsboro, PA
National Provider Identifier
1184635286
Registry record updated Oct 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD025213E Issued in PA
Legal business name
GRADY D. GAFFORD MD PC
Practice address
15 Meade St
Suite 1
Wellsboro, PA 16901-1813
Phone
(570) 724-2131
Fax
(570) 724-5471
NPI assigned
Aug 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2009

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

Authorized official

Name
Mrs. Colleen K. Strahota
Title
Administrator
Phone
(570) 724-2131

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X OEG000806 PA
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X MD025213E PA Primary

Addresses

Primary practice location

15 Meade St
Suite 1
Wellsboro, PA 16901-1813

Mailing address

15 Meade St
Suite 1
Wellsboro, PA 16901-1813
Phone (570) 724-2131

Other identifiers 1

IdentifierTypeStateIssuer
001045419MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050420000869 PA Part B Supplier - Clinic/Group Practice 0042258048 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
Practice locations: Towanda, PA; Wellsboro, PA; Troy, PA
O20100930088807 PA DME Supplier - Physician - OphthalmologyDME Supplier - Optician 0042258048 Practice locations: Wellsboro, PA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Grady D Gafford MD PC15 Meade St, Wellsboro, PA 16901-1813(570) 724-2131 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Sep 13, 1990

National Provider Directory

National Provider Directory
Tax ID family
Grady D Gafford MD PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

15 Meade St
Ste 1
Wellsboro, PA 16901
Phone (570) 724-2131

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254873600000",
    "number": "1184635286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 MEADE ST",
            "address_2": "SUITE 1",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011813",
            "telephone_number": "570-724-2131",
            "fax_number": "570-724-5471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 MEADE ST",
            "address_2": "SUITE 1",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011813",
            "telephone_number": "570-724-2131",
            "fax_number": "570-724-5471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRADY D. GAFFORD MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2009-10-07",
        "status": "A",
        "authorized_official_last_name": "STRAHOTA",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "570-724-2131",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000806",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "PA",
            "license": "MD025213E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001045419",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellsboro, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.