Nicholas J Grande Jr., PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

1227 E Rusholme St
Davenport, IA 52803-2459

Phone

(563) 421-1000

NPI assigned

Feb 1, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA, IL, CA3 enrollments

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 3

Specialty

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carbon Health Medical Group of California PCGroup PAC ID 9032340047, 335 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Carbon Health Medical Group of California PC

  • Urgent Care Clinic/Center
  • Berkeley, CA
  • NPI 1417294232
  Medicare reassignment Care Compare group NPD
• Genesis Health System

  • Family Medicine Physician
  • Davenport, IA
  • NPI 1477654945

  IL

  Medicare reassignment NPD
• Genesis Health System

  • Clinic/Center
  • Bettendorf, IA
  • NPI 1497772008
  Medicare reassignment
• Genesis Health System

  • Anatomic Pathology & Clinical Pathology Physician
  • Davenport, IA
  • NPI 1295196798
  NPD
• Genesis Health System

  • Critical Access Hospital
  • De Witt, IA
  • NPI 1649368523
  NPD
• Carbon Health Medical Group of California PC

  • Urgent Care Clinic/Center
  • Pasadena, CA
  • NPI 1255957205
  NPD
• Carbon Health Primary Care of California PC

  • Multi-Specialty Clinic/Center
  • Berkeley, CA
  • NPI 1972057990
  NPD (past)

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676505600000",
    "number": "1316085756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 HUEBNER RD",
            "city": "FORT RILEY",
            "state": "KS",
            "postal_code": "664424030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 E RUSHOLME ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528032459",
            "telephone_number": "563-421-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDE",
        "first_name": "NICHOLAS",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roopa M Goswami, M.D.
• Bettaiah T Gowda, M.D.
• Lisa Grace, D.C.
• Christine Gradert, L.I.S.W.
• Polly Rae Graham, MBA, RD, LD
• Katie L Grant, MS, LCPC, LMHC, LPC
• Tina L Graw, MA
• Great Plains Orthotics & Prosthetics, Inc
• Great River Medical Group
• Green Country Dialysis LLC

• Medical Physician Assistant in Davenport, IA
• Providers in Davenport, IA by specialty
• Medical Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.