Active NPI
Richard William Graham, D.M.D., MSD
- Periodontics
- Spartanburg, SC
National Provider Identifier
1366547341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 2984
- Practice address
- 456 Patillo CT
Spartanburg, SC 29301 - Phone
- (864) 582-1415
- Fax
- (864) 582-1441
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 2984 | SC | Primary |
Addresses
Primary practice location
456 Patillo CT
Spartanburg, SC 29301
Mailing address
456 Patillo CT
Spartanburg, SC 29302
Phone (864) 582-1415
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140226000724 | SC | Order and Referring Only - Oral Surgery | 7315177078 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2984 | SC | MD | Chiropractor |
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": "1447286400000",
"number": "1366547341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "456 PATILLO CT",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "29302",
"telephone_number": "864-582-1415",
"fax_number": "864-582-1441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "456 PATILLO CT",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "29301",
"telephone_number": "864-582-1415",
"fax_number": "864-582-1441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "RICHARD",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "D.M.D., MSD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2015-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "SC",
"license": "2984",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spartanburg, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2015; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.