Individual provider Active NPI

Grigor Grigoryan, FNP-C

  • Family Nurse Practitioner
  • Fresno, CA
National Provider Identifier
1205382231
Registry record updated Dec 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95004882 Issued in CA
Practice address
7335 N 1St St
109
Fresno, CA 93720-2968
Phone
(559) 449-1209
NPI assigned
Aug 30, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95004882 CA Primary

Addresses

Primary practice location

7335 N 1St St
109
Fresno, CA 93720-2968

Mailing address

7335 N 1St St
Fresno, CA 93720-2968
Phone (559) 449-1209

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20210416001026 CA Practitioner - Nurse Practitioner 5496163248 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrative Psychiatry a Medical CorporationGroup PAC ID 4587057286, 8 clinicians

Practice addresses (Care Compare)

29982 Ivy Glenn Dr
Suite 203
Laguna Niguel, CA 92677-2097
Phone (949) 309-7903

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Integrative Psychiatry a Medical Corporation CurrentSince Mar 19, 2021 Accepting new patients

Locations

29982 Ivy Glenn Dr
Ste 203
Laguna Niguel, CA 92677
Phone (949) 309-7903

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1472515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481587200000",
    "number": "1205382231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7335 N 1ST ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202968",
            "telephone_number": "559-449-1209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7335 N 1ST ST",
            "address_2": "109",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202968",
            "telephone_number": "559-449-1209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIGORYAN",
        "first_name": "GRIGOR",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-30",
        "last_updated": "2016-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95004882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.