Active NPI
Mark Joseph Grever, DO
- Emergency Medicine Physician
- Edgewood, KY
National Provider Identifier
1467453258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 02310
- Practice address
- 1 Medical Village Dr
Edgewood, KY 41017-3403 - Phone
- (859) 301-2250
- Fax
- (859) 572-2326
- NPI assigned
- Aug 3, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 02006148A | IN | |
| Emergency Medicine Physician | 207P00000X | 02310 | KY | Primary |
Addresses
Primary practice location
1 Medical Village Dr
Edgewood, KY 41017-3403
Mailing address
PO Box 18667
Erlanger, KY 41018-0667
Phone (859) 572-3617
Other practice location 1
1500 James Simpson Jr Way
Covington, KY 41011-0801
Phone (859) 655-4353
Other practice location 2
238 Barnes Rd
Williamstown, KY 41097-9482
Phone (859) 824-8240
Other practice location 3
4900 Houston Rd
Florence, KY 41042-4824
Phone (859) 212-5441
Other practice location 4
600 Wilson Creek Rd
Lawrenceburg, IN 47025-2751
Phone (812) 537-1010
Other practice location 5
85 N Grand Ave
Fort Thomas, KY 41075-1793
Phone (859) 572-3618
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64055767 | Medicaid | KY | |
| 0538841 | Medicaid | OH | |
| 200940250 | Medicaid | IN |
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 Osteopathy, Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622592000000",
"number": "1467453258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 18667",
"city": "ERLANGER",
"state": "KY",
"postal_code": "410180667",
"telephone_number": "859-572-3617",
"fax_number": "859-572-2326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 MEDICAL VILLAGE DR",
"city": "EDGEWOOD",
"state": "KY",
"postal_code": "410173403",
"telephone_number": "859-301-2250",
"fax_number": "859-572-2326"
}
],
"practiceLocations": [
{
"address_1": "1500 James Simpson Jr Way",
"address_purpose": "LOCATION",
"city": "Covington",
"state": "KY",
"postal_code": "410110801",
"country_code": "US",
"telephone_number": "859-655-4353",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "238 Barnes Rd",
"address_purpose": "LOCATION",
"city": "Williamstown",
"state": "KY",
"postal_code": "410979482",
"country_code": "US",
"telephone_number": "859-824-8240",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4900 Houston Rd",
"address_purpose": "LOCATION",
"city": "Florence",
"state": "KY",
"postal_code": "410424824",
"country_code": "US",
"telephone_number": "859-212-5441",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "600 Wilson Creek Rd",
"address_purpose": "LOCATION",
"city": "Lawrenceburg",
"state": "IN",
"postal_code": "470252751",
"country_code": "US",
"telephone_number": "812-537-1010",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "85 N Grand Ave",
"address_purpose": "LOCATION",
"city": "Fort Thomas",
"state": "KY",
"postal_code": "410751793",
"country_code": "US",
"telephone_number": "859-572-3618",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GREVER",
"first_name": "MARK",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-03",
"last_updated": "2021-06-02",
"certification_date": "2021-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IN",
"license": "02006148A",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "KY",
"license": "02310",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64055767",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0538841",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200940250",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Edgewood, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.