Carly Cook Granata, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110007055 Issued in VA

Practice address

10236 Lake Arbor Way
Mitchellville, MD 20721-3113

Phone

(240) 436-2840

NPI assigned

Jan 11, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Carly Jane Cook Former name

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: carly.cook@hca6.eclinicaldirectplus.com
• Direct secure messaging: carly.granata.1@14940.direct.athenahealth.com

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.

• Everside Health, LLC

  • Primary Care Clinic/Center
  • Lanham, MD
  • NPI 1386109478
  NPD (past)
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1547164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654819200000",
    "number": "1396219408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10236 LAKE ARBOR WAY",
            "city": "MITCHELLVILLE",
            "state": "MD",
            "postal_code": "207213113",
            "telephone_number": "404-362-8402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10236 LAKE ARBOR WAY",
            "city": "MITCHELLVILLE",
            "state": "MD",
            "postal_code": "207213113",
            "telephone_number": "240-436-2840"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "37 Glendale Ct",
            "address_purpose": "LOCATION",
            "city": "Troutville",
            "state": "VA",
            "postal_code": "241756538",
            "country_code": "US",
            "telephone_number": "540-355-1688",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4901 Brambleton Ave",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240184149",
            "country_code": "US",
            "telephone_number": "540-777-4000",
            "fax_number": "540-777-7007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRANATA",
        "first_name": "CARLY",
        "middle_name": "COOK",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-11",
        "last_updated": "2022-06-10",
        "certification_date": "2022-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0008389",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110007055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "COOK",
            "middle_name": "JANE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Olurotimi Samuel Fowowe
• Kenny Gaston
• Alexia I Georges
• Audra N Gillis, MSW
• Danya Gordon, LGPC
• Ariane Z Grant, PT, DPT
• Jeri Gresham, MA
• Miari-Ann H Griffith, DDS
• Katherine Grove
• Courtney Haggins

• Physician Assistant in Mitchellville, MD
• Providers in Mitchellville, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2022; 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.

Verify at the official NPI Registry.