Active NPI
Roger C Grayson, PAC MPAB
- Physician Assistant
- Tacoma, WA
National Provider Identifier
1285713271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 419 South L Street Suite 101
Tacoma, WA 98405 - Phone
- (253) 383-5949
- Fax
- (253) 383-5953
- NPI assigned
- Nov 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
419 South L Street Suite 101
Tacoma, WA 98405
Mailing address
419 South L Street Suite 101
Tacoma, WA 98405
Phone (253) 383-5949
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR6977 | Other | WA | REGENCE BLUE SHIELD |
| 1784206 | Other | WA | PREMERA BLUE CROSS |
| GAB25485 | Other | WA | MEDICARE PIERCE COUNTY |
| 8357030 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195603200000",
"number": "1285713271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "419 SOUTH L STREET SUITE 101",
"city": "TACOMA",
"state": "WA",
"postal_code": "98405",
"telephone_number": "253-383-5949",
"fax_number": "253-383-5953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "419 SOUTH L STREET SUITE 101",
"city": "TACOMA",
"state": "WA",
"postal_code": "98405",
"telephone_number": "253-383-5949",
"fax_number": "253-383-5953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAYSON",
"first_name": "ROGER",
"middle_name": "C",
"credential": "PAC MPAB",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-02",
"last_updated": "2007-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "GR6977",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREMERA BLUE CROSS",
"identifier": "1784206",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PIERCE COUNTY",
"identifier": "GAB25485",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8357030",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.