Individual provider Active NPI

Corey French Graham, M.D.

  • Surgery Physician
  • Warsaw, IN
National Provider Identifier
1316109317
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
01074316A Issued in IN
Practice address
1000 Provident Dr
Suite C
Warsaw, IN 46580-3255
Phone
(574) 267-8728
Fax
(574) 269-3470
NPI assigned
Jun 30, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 01074316A IN Primary

Addresses

Primary practice location

1000 Provident Dr
Suite C
Warsaw, IN 46580-3255

Mailing address

7916 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone (260) 434-6071

Other identifiers 2

IdentifierTypeStateIssuer
262490014OtherINMEDICARE PTAN
201246970MedicaidIN

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address COREY.GRAHAM@lutheranhealthnetwork.cernerdirect.com
Direct Messaging Address corey.graham@lutheranhealthnetwork.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140807000751 IN Practitioner - General Surgery 0244457786 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Michigan State University College of Human Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kosciusko Medical Group LLCGroup PAC ID 5496809956, 41 clinicians

Practice addresses (Care Compare)

107 W Pickwick Dr a
Syracuse, IN 46567-1832
Phone (574) 457-8585

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.99 of 100Reported as apm
Quality
77.41
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy54
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux39
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01074316AINMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kosciusko Medical Group LLC Surgery CurrentSince Aug 18, 2014 Accepting new patients

Locations

7950 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 434-7088

605 N Walnut St
North Manchester, IN 46962
Phone (219) 982-1994

107 W Pickwick Dr
Ste A
Syracuse, IN 46567
Phone (574) 457-8585

1205 Provident Dr
#A
Warsaw, IN 46580
Phone (574) 269-8383

2101 Dubois Dr
Warsaw, IN 46580
Phone (219) 267-3200

2235 Dubois Dr
Warsaw, IN 46580
Phone (260) 423-2567

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.

Hospital & facility affiliations 2

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": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1316109317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7916 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-434-6071",
            "fax_number": "260-434-6389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 PROVIDENT DR",
            "address_2": "SUITE C",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803255",
            "telephone_number": "574-267-8728",
            "fax_number": "574-269-3470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "COREY",
        "middle_name": "FRENCH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-30",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01074316A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "262490014",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201246970",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "COREY.GRAHAM@lutheranhealthnetwork.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "1000 Provident Dr",
            "address_2": "Suite C",
            "city": "Warsaw",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465803255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "corey.graham@lutheranhealthnetwork.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "1000 Provident Dr",
            "address_2": "Suite C",
            "city": "Warsaw",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465803255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Warsaw, IN

Sources for this page

Verify at the official NPI Registry.