NPIMap

Individual provider Active NPI

Gregg Travis Graham, FNP

  • Family Nurse Practitioner
  • Concord, NC
National Provider Identifier
1356401574
Registry record updated Jun 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5011714 Issued in NC
Practice address
354 Copperfield Blvd NE
Concord, NC 28025-2402
Phone
(704) 786-5122
Fax
(704) 782-8279
NPI assigned
Dec 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5011714 NC Primary
Nurse Practitioner 363L00000X ARNP9332853 FL

Addresses

Primary practice location

354 Copperfield Blvd NE
Concord, NC 28025-2402

Mailing address

4601 Park Rd Ste 300
Charlotte, NC 28209-2290
Phone (704) 323-2090

Other practice location 1

1110 Hospital Road
Orthopedic Surgery Department
Fort Walton Beach, FL 32547-6796
Phone (850) 863-8235

Other identifiers 1

IdentifierTypeStateIssuer
0397730026OtherNCNSC#

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190612000636 NC Practitioner - Nurse Practitioner 1557384211 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
OrthocarolinaGroup PAC ID 2062316821, 288 clinicians

Practice addresses (Care Compare)

354 Copperfield Blvd NE
Concord, NC 28025-2402
Phone (704) 323-2276

Hospital & facility affiliations

  • Carolinas Medical Center-Northeast Hospital, Concord, NC, CCN 340001
  • Duke Health Lake Norman Hospital Hospital, Mooresville, NC, CCN 340129
  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113
  • Stanly Regional Medical Center Hospital, Albemarle, NC, CCN 340119

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP9332853FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Orthocarolina CurrentSince Jun 10, 2019 Accepting new patients
Orthocarolina Nurse Practitioner Current Accepting new patients
Orthocarolina CurrentSince Jun 10, 2019 Accepting new patients
Orthocarolina Past Accepting new patients
Pueblo Orthopedic Professional Corporation Past Accepting new patients

Locations

1915 Randolph Rd
Charlotte, NC 28207
Phone (704) 339-1000

4601 Park Rd
Ste 300
Charlotte, NC 28209
Phone (704) 323-2090

354 Copperfield Blvd NE
Concord, NC 28025
Phone (704) 262-4181

Interoperability endpoints

  • Direct secure messaging: ggraham663956@direct.medicine.duke.edu

Organizations & group practices 5

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 11

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": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559606400000",
    "number": "1356401574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 PARK RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282092290",
            "telephone_number": "704-323-2090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 COPPERFIELD BLVD NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252402",
            "telephone_number": "704-786-5122",
            "fax_number": "704-782-8279"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1110 Hospital Road",
            "address_2": "Orthopedic Surgery Department",
            "address_purpose": "LOCATION",
            "city": "Fort Walton Beach",
            "state": "FL",
            "postal_code": "325476796",
            "country_code": "US",
            "telephone_number": "850-863-8235",
            "fax_number": "850-863-6619",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "GREGG",
        "middle_name": "TRAVIS",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2019-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5011714",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9332853",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NSC#",
            "identifier": "0397730026",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.