Grissim Clark Connery, DO, RD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

DO3640 Issued in NV

Practice address

1707 W Charleston Blvd Ste 100
Las Vegas, NV 89102-2352

Phone

(702) 676-3650

Fax

(702) 671-5198

NPI assigned

May 15, 2012

Last updated

Jul 10, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Unlv Medicine

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1407397235
  Medicare reassignment NPD
• Unlv Medicine

  dba Mojave Pharmacy

  • Community/Retail Pharmacy
  • Las Vegas, NV
  • NPI 1184152274
  NPD
• Unlv Medicine

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Las Vegas, NV
  • NPI 1538694575
  NPD
• University Medical Center of Southern Nevada

  dba University Medical Center

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1548393127
  NPD (past)

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

{
    "created_epoch": "1337040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1427317155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3016 W CHARLESTON BLVD STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021973",
            "telephone_number": "702-780-2315",
            "fax_number": "702-895-4014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 W CHARLESTON BLVD STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022352",
            "telephone_number": "702-676-3650",
            "fax_number": "702-671-5198"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1701 W Charleston Blvd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891022312",
            "country_code": "US",
            "telephone_number": "702-660-8658",
            "fax_number": "702-676-3635",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONNERY",
        "first_name": "GRISSIM",
        "middle_name": "CLARK",
        "name_prefix": "Mr.",
        "credential": "DO, RD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-15",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "1086129",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "DO3640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John N Conner III, HS DIPLOMA
• Ryan Conner
• Sarah Conner
• Lisa Marjorie Conners, DO
• Michelle Susan Conners, FNP
• Connexions Mental Health Services, LLC
• Connolly Care for Children LLC
• Connolly Care Hospice LLC
• Connolly Enterprises LLC (Connolly Care)
• Bryan Connolly

• Internal Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Internal Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.