Individual provider Active NPI

Grant Edward Stevens, HIS

  • Hearing Instrument Specialist
  • Port Charlotte, FL
National Provider Identifier
1407178486
Registry record updated Jun 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hearing Instrument SpecialistTaxonomy code 237700000X
License
AS-4012 Issued in FL
Practice address
2866 Tamiami TRL Ste D
Port Charlotte, FL 33952
Phone
(941) 249-9142
Fax
(941) 377-0808
NPI assigned
Feb 18, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hearing Instrument Specialist 237700000X AS-4012 FL Primary

Addresses

Primary practice location

2866 Tamiami TRL Ste D
Port Charlotte, FL 33952

Mailing address

5969 Cattleridge Blvd Ste 100
Sarasota, FL 34232-6050
Phone (941) 249-9142

Other practice location 1

5969 Cattleridge Blvd Ste 100
Sarasota, FL 34232-6050
Phone (941) 249-9142

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
AS-4012FLMDHearing Instrument Specialist

NPI Registry JSON

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

{
    "created_epoch": "1266451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528761600000",
    "number": "1407178486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5969 CATTLERIDGE BLVD STE 100",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342326050",
            "telephone_number": "941-249-9142",
            "fax_number": "941-377-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2866 TAMIAMI TRL STE D",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "33952",
            "telephone_number": "941-249-9142",
            "fax_number": "941-377-0808"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5969 Cattleridge Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Sarasota",
            "state": "FL",
            "postal_code": "342326050",
            "country_code": "US",
            "telephone_number": "941-249-9142",
            "fax_number": "941-377-0808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "GRANT",
        "middle_name": "EDWARD",
        "credential": "HIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-18",
        "last_updated": "2018-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "FL",
            "license": "AS-4012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2018; 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.