NPIMap

Organization Active NPI

Graybeal Orthopedic, LLC

Doing business as Anchor Brace and Limb

  • Prosthetic/Orthotic Supplier
  • Johnson City, TN
National Provider Identifier
1265452650
Registry record updated May 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
GRAYBEAL ORTHOPEDIC, LLC
Doing business as
Anchor Brace and Limb
Practice address
107 E Myrtle Ave
Johnson City, TN 37601-4631
Phone
(423) 975-9884
Fax
(423) 975-6678
NPI assigned
Jul 20, 2006
Last updated
May 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2020

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

Authorized official

Name
Mr. Adam Fann, CPO
Title
Owner
Phone
(423) 975-9884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

107 E Myrtle Ave
Johnson City, TN 37601-4631

Mailing address

107 E Myrtle Ave
Johnson City, TN 37601-4631
Phone (423) 975-9884

Other identifiers 2

IdentifierTypeStateIssuer
1452173MedicaidTN
003035088OtherTNBCBS OF TN

Other names 1

  • Anchor Brace and Limb Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930083971 TN DME Supplier - Prosthetic PersonnelDME Supplier - Orthotic Personnel 2163542234 Practice locations: Johnson City, TN

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Graybeal Orthopedic LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590537600000",
    "number": "1265452650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 E MYRTLE AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376014631",
            "telephone_number": "423-975-9884",
            "fax_number": "423-975-6678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E MYRTLE AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376014631",
            "telephone_number": "423-975-9884",
            "fax_number": "423-975-6678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAYBEAL ORTHOPEDIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2020-05-27",
        "certification_date": "2020-05-27",
        "status": "A",
        "authorized_official_last_name": "FANN",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-975-9884",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1452173",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TN",
            "identifier": "003035088",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anchor Brace and Limb",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.