Individual provider Active NPI

Mark Joseph Grever, DO

  • Emergency Medicine Physician
  • Edgewood, KY
National Provider Identifier
1467453258
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
02310 Issued in KY
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

Updated by the provider on Jun 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
64055767MedicaidKY
0538841MedicaidOH
200940250MedicaidIN

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.

Verify at the official NPI Registry.