Justin Ryder Grametbaur, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA04263 Issued in TX

Practice address

2104 W Michigan Ave
Midland, TX 79701-5928

Phone

(432) 570-9552

Fax

(432) 570-9859

NPI assigned

Mar 28, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Permian Basin Community Centers for Mental Health & Mental Retardation

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Alpine, TX
  • NPI 1851464119
  NPD (past)

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346369527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 W MICHIGAN AVE",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797015928",
            "telephone_number": "432-570-9552",
            "fax_number": "432-570-9859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 W MICHIGAN AVE",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797015928",
            "telephone_number": "432-570-9552",
            "fax_number": "432-570-9859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAMETBAUR",
        "first_name": "JUSTIN",
        "middle_name": "RYDER",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bailey Catherine Goodrum, M.S., CCC-SLP
• Gordon W. Dyer, LLC
• Rick L Gordon, PT
• Natalie Nicole Gould, WHNP-BC
• Sajida Gowani, PHARMD
• Latasha Grant
• Tyler Mickell Grant
• Jennifer Graves
• Gray Cosmetic & Family Dentistry
• Gray Cosmetic and Family Dentistry

• Physician Assistant in Midland, TX
• Providers in Midland, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.