Active NPI
Grant T Roderer, MD
- Pain Medicine (Anesthesiology) Physician
- Anchorage, AK
National Provider Identifier
1437170586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pain Medicine (Anesthesiology) Physician
- License
- AK4470
- Practice address
- 1917 Abbott Rd
Suite 100
Anchorage, AK 99507 - Phone
- (907) 278-2741
- Fax
- (907) 743-8284
- NPI assigned
- Jul 22, 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 |
|---|---|---|---|---|
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | AK4470 | AK | Primary |
Addresses
Primary practice location
1917 Abbott Rd
Suite 100
Anchorage, AK 99507
Mailing address
1917 Abbott Rd
Suite 100
Anchorage, AK 99507-3448
Phone (907) 278-2741
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD0183 | Medicaid | AK |
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 |
|---|---|---|---|
| 1362 | AZ | MD | Psychologist |
| AK4470 | AK | MD | Pain Medicine (Anesthesiology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361923200000",
"number": "1437170586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1917 ABBOTT RD",
"address_2": "SUITE 100",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995073448",
"telephone_number": "907-278-2741",
"fax_number": "907-743-8284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1917 ABBOTT RD",
"address_2": "SUITE 100",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "99507",
"telephone_number": "907-278-2741",
"fax_number": "907-743-8284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODERER",
"first_name": "GRANT",
"middle_name": "T",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-22",
"last_updated": "2013-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "207LP2900X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pain Medicine",
"state": "AK",
"license": "AK4470",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "MD0183",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
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- Laticia Larea Roderick
- Thomas Fraiser Rodger, LPC
- Cesar Rodgers, MA
- Gregory L Rodgers, RT
- Regan M Rodig, LMT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.