Active NPI
Jack G Gracey, M.D.
- Cardiovascular Disease Physician
- Lancaster, PA
National Provider Identifier
1376590372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- MD028611L
- Practice address
- 802 New Holland Ave
Suite 200
Lancaster, PA 17602-2163 - Phone
- (717) 358-1305
- Fax
- (717) 291-9634
- NPI assigned
- May 27, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | MD028611L | PA | Primary |
Addresses
Primary practice location
802 New Holland Ave
Suite 200
Lancaster, PA 17602-2163
Mailing address
802 New Holland Ave
Suite 200
Lancaster, PA 17602-2163
Phone (717) 358-1305
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000696452001 | Medicaid | PA |
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
| License | State | Type | Specialty |
|---|---|---|---|
| MD028611L | PA | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cardiac Diagnostic Associates, PC | Cardiovascular Disease | Past | Accepting new patients |
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.
-
- Cardiovascular Disease Physician
- York, PA
- NPI 1275584401
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341273600000",
"number": "1376590372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "802 NEW HOLLAND AVE",
"address_2": "SUITE 200",
"city": "LANCASTER",
"state": "PA",
"postal_code": "176022163",
"telephone_number": "717-358-1305",
"fax_number": "717-291-9634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "802 NEW HOLLAND AVE",
"address_2": "SUITE 200",
"city": "LANCASTER",
"state": "PA",
"postal_code": "176022163",
"telephone_number": "717-358-1305",
"fax_number": "717-291-9634"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRACEY",
"first_name": "JACK",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-27",
"last_updated": "2012-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "PA",
"license": "MD028611L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000696452001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lancaster, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.