Individual provider Active NPI

Paul B. Graniero, M.D.

  • Family Medicine Physician
  • Port Charlotte, FL
National Provider Identifier
1205868981
Registry record updated Nov 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME55719 Issued in FL
Practice address
21297 Olean Blvd Ste a
Port Charlotte, FL 33952-6704
Phone
(855) 979-5700
Fax
(855) 979-5701
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME55719 FL Primary

Addresses

Primary practice location

21297 Olean Blvd Ste a
Port Charlotte, FL 33952-6704

Mailing address

2675 Winkler Ave FL 2Floor
Fort Myers, FL 33901-9342
Phone (877) 856-3774

Other identifiers 2

IdentifierTypeStateIssuer
080111648OtherRAILROAD MEDICARE
09903OtherBLUECROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050503000927 FL Practitioner - HospitalistPractitioner - Family Practice 7911947528 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians

Practice addresses (Care Compare)

2315 Aaron St
Port Charlotte, FL 33952-5305
Phone (941) 613-2222

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME55719FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physician Group LLC Family Medicine CurrentSince Aug 1, 2009 Accepting new patients
Millennium Physician Group LLC Family Medicine CurrentSince Aug 1, 2009 Accepting new patients
Murdock Family Medicine LLC Family Medicine Past Accepting new patients

Locations

2675 Winkler Ave
Fl 2
Fort Myers, FL 33901
Phone (855) 979-5700

3434 Hancock Bridge Pkwy
Ste 301
North Ft Myers, FL 33903
Phone 877856377411108

3434 Hancock Bridge Pkwy
North Ft Myers, FL 33903

2351 Aaron St
Port Charlotte, FL 33952
Phone (855) 674-7500

2315 Aaron St
Port Charlotte, FL 33952
Phone (941) 613-2222

21297 Olean Blvd
#A
Pt Charlotte, FL 33952
Phone (855) 979-5700

2450 Tamiami Trl
Ste A
Pt Charlotte, FL 33952
Phone (941) 235-3447

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574812800000",
    "number": "1205868981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2FLOOR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774",
            "fax_number": "239-599-2625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21297 OLEAN BLVD STE A",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526704",
            "telephone_number": "855-979-5700",
            "fax_number": "855-979-5701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANIERO",
        "first_name": "PAUL",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2019-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME55719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080111648",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUE SHIELD",
            "identifier": "09903",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.