NPIMap

Individual provider Active NPI

Lisa M Porter-Grenn, MD

  • Diagnostic Radiology Physician
  • Madison Heights, MI
National Provider Identifier
1457361792
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
4301407005 Issued in MI
Practice address
27379 Dequindre
Madison Heights, MI 48071
Phone
(248) 398-4488
Fax
(248) 398-4995
NPI assigned
Aug 9, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 4301407005 MI Primary

Addresses

Primary practice location

27379 Dequindre
Madison Heights, MI 48071

Mailing address

735 Fairfax St
Birmingham, MI 48009
Phone (248) 647-5774

Other identifiers 1

IdentifierTypeStateIssuer
3349763MedicaidMI

Other names 1

  • Lisa M Grenn Other name

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

Practice roles

OrganizationSpecialtyStatusNew patients
Proscan Imaging Southfield PLLC Diagnostic Radiology PastSince Mar 28, 2019 Accepting new patients
Open MRI of Michigan Past Accepting new patients
Barbara Ann Karmanos Cancer Institute Past Accepting new patients
Open MRI of Michigan LLC Diagnostic Radiology Past Accepting new patients
Advanced MRI Imaging, PLLC Diagnostic Radiology PastSince Sep 14, 2008 Accepting new patients
Barbara Ann Karmanos Cancer Institute Past Accepting new patients
Michigan Orthopaedic Institute, P.C. PastSince Nov 30, 2015 Accepting new patients
Amd Southfield Michigan - Limited Partnership Past Accepting new patients

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457361792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 FAIRFAX ST",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "48009",
            "telephone_number": "248-647-5774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27379 DEQUINDRE",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "48071",
            "telephone_number": "248-398-4488",
            "fax_number": "248-398-4995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER-GRENN",
        "first_name": "LISA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301407005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3349763",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "GRENN",
            "middle_name": "M",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Madison Heights, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.