Grand Ave Family Medicine

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

GRAND AVE FAMILY MEDICINE

Practice address

3236 E Grand Ave Ste D
Laramie, WY 82070-5100

Phone

(970) 231-3498

NPI assigned

May 29, 2023

Organization subpart

No

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

Authorized official

Name

John Jacobs III, NPNPI 1497184378

Title

Owner

Phone

(970) 231-3498

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicole N Alexander, PA-C

  • Physician Assistant
  • Laramie, WY
  • NPI 1831439108
  Medicare reassignment Care Compare group NPD
• Christina Cook, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Laramie, WY
  • NPI 1891346516
  Medicare reassignment Care Compare group NPD
• John Jacobs III, NP-C

  • Acute Care Nurse Practitioner
  • Laramie, WY
  • NPI 1497184378
  NPD Authorized official
• Jesse Henry, FNP

  • Family Nurse Practitioner
  • Laramie, WY
  • NPI 1649407040
  NPD (past)
• Philip Lerory Sanders III, FNP-C

  • Family Nurse Practitioner
  • Laramie, WY
  • NPI 1477109445
  NPD (past)

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

{
    "created_epoch": "1685318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685318400000",
    "number": "1437842390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3236 E GRAND AVE STE D",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705100",
            "telephone_number": "970-231-3498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3236 E GRAND AVE STE D",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705100",
            "telephone_number": "970-231-3498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND AVE FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-29",
        "last_updated": "2023-05-29",
        "certification_date": "2023-05-27",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-231-3498",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Demetre Gostas
• Grace Counseling
• Kassidy Graham, LPC
• Susan Graham
• Tonja Graham
• Grand Avenue Dental Care
• Grand Avenue Urgent Care, LLC
• Carl Granderson
• Kylie Graney, DDS
• Shanae Grant

• Family Medicine Physician in Laramie, WY
• Providers in Laramie, WY by specialty
• Family Medicine Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.