Individual provider Active NPI

Mitchell Gregg, M.D.

  • Diagnostic Radiology Physician
  • Village of Palmetto Bay, FL
National Provider Identifier
1366547325
Registry record updated Jan 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
ME0018008 Issued in FL
Practice address
9333 SW 152ND St
Village of Palmetto Bay, FL 33157-1778
Phone
(305) 665-4614
Fax
(305) 667-0239
NPI assigned
Sep 14, 2006
Last updated
Jan 7, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X ME0018008 FL Primary

Addresses

Primary practice location

9333 SW 152ND St
Village of Palmetto Bay, FL 33157-1778

Mailing address

5901 SW 74TH St
Suite 202
Miami, FL 33143-5165
Phone (305) 665-4614

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
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME0018008FLMDDiagnostic Radiology Physician
18008FLMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Life Radiology LLC Past Accepting new patients
Coral Reef Radiology Associates PA Diagnostic Radiology PastSince Mar 26, 2011 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357516800000",
    "number": "1366547325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 SW 74TH ST",
            "address_2": "SUITE 202",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331435165",
            "telephone_number": "305-665-4614",
            "fax_number": "305-667-0239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9333 SW 152ND ST",
            "city": "VILLAGE OF PALMETTO BAY",
            "state": "FL",
            "postal_code": "331571778",
            "telephone_number": "305-665-4614",
            "fax_number": "305-667-0239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREGG",
        "first_name": "MITCHELL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2013-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME0018008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Village of Palmetto Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2013; 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.