Active NPI
Mark E Grandon, PA-C
- Surgical Physician Assistant
- Louisville, KY
National Provider Identifier
1386683852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA155
- Practice address
- 3 Audubon Plaza Dr
Suite 560
Louisville, KY 40217-1319 - Phone
- (502) 636-8004
- Fax
- (502) 636-8384
- NPI assigned
- Jun 6, 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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA155 | KY | Primary |
Addresses
Primary practice location
3 Audubon Plaza Dr
Suite 560
Louisville, KY 40217-1319
Mailing address
PO Box 776351
Chicago, IL 60677-6351
Phone (502) 588-9490
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121030 | Other | KY | SIHO - CTS |
| 50032501 | Other | KY | PASSPORT/PASSPORT ADVANTAGE - CTS |
| 95001558 | Medicaid | KY | |
| 000000689934 | Other | KY | ANTHEM - CTS |
| 1299470001 | Other | KY | PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1 Audubon Plaza Dr
Louisville, KY 40217-1318
Phone (502) 636-7225
200 E Chestnut St
Louisville, KY 40202-1831
Phone (502) 893-1270
825 Barret Ave
Louisville, KY 40204-1743
Phone (502) 272-5165
Hospital & facility affiliations
- Norton Hospitals, Inc
Merit-based Incentive Payment System (MIPS)
- Final score
- 81.11 of 100
- Quality
- 63.34
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 73.68
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA155 | KY | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Medical Associates, Inc. | Current | Accepting new patients | |
| Community Medical Associates | Current | Accepting new patients |
Locations
3 Audubon Plaza Dr
Ste 560
Louisville, KY 40217
Phone (502) 636-8004
825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165
Interoperability endpoints
- mgrandon11011@direct.nortonhealthcare.org
Organizations & group practices 3
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.
-
- Multi-Specialty Clinic/Center
- Louisville, KY
- NPI 1306983762
-
- Radiology Clinic/Center
- Elizabethtown, KY
- NPI 1669245510
-
- Internal Medicine Physician
- Louisville, KY
- NPI 1881192409
Hospital & facility affiliations 14
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Louisville, KY
- NPI 1043348808
-
- General Acute Care Hospital
- Louisville, KY
- NPI 1447388335
-
- General Acute Care Hospital
- Louisville, KY
- NPI 1699514463
-
- General Acute Care Hospital
- Louisville, KY
- NPI 1831195908
-
- General Acute Care Hospital
- Louisville, KY
- NPI 1891799227
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468022400000",
"number": "1386683852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 776351",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606776351",
"telephone_number": "502-588-9490",
"fax_number": "502-272-5116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 AUDUBON PLAZA DR",
"address_2": "SUITE 560",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402171319",
"telephone_number": "502-636-8004",
"fax_number": "502-636-8384"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANDON",
"first_name": "MARK",
"middle_name": "E",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-06",
"last_updated": "2016-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "KY",
"license": "PA155",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SIHO - CTS",
"identifier": "121030",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT/PASSPORT ADVANTAGE - CTS",
"identifier": "50032501",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "95001558",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM - CTS",
"identifier": "000000689934",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "1299470001",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2016; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.