NPIMap

Individual provider Active NPI

Dyllen Grossman, D.O.

  • Internal Medicine Physician
  • Henderson, NV
National Provider Identifier
1467802082
Registry record updated Jul 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DO2474 Issued in NV
Practice address
10624 S Eastern Ave # a-955
Henderson, NV 89052-2982
Phone
(702) 800-5393
Fax
(702) 407-7016
NPI assigned
Jun 14, 2016
Last updated
Jul 30, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X DO2474 NV Primary

Addresses

Primary practice location

10624 S Eastern Ave # a-955
Henderson, NV 89052-2982

Mailing address

10624 S Eastern Ave # a-955
Henderson, NV 89052-2982
Phone (702) 800-5393

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190701002278 NV Practitioner - Internal Medicine 6305139262 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Platinum Hospitalists LLPGroup PAC ID 7214076322, 197 clinicians

Practice addresses (Care Compare)

201 N Buffalo Dr
Las Vegas, NV 89145-0373
Phone 70224227372

7495 W Azure Dr
Suite 209
Las Vegas, NV 89130-4440
Phone (702) 407-7700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
62.43 of 100Reported as individual
Quality
58.12
Improvement activities
0
Cost
68.45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO2474NVMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Platinum Hospitalists LLP Family Medicine CurrentSince Jul 1, 2019 Accepting new patients
Platinum Hospitalists LLP Family Medicine CurrentSince Jul 1, 2019 Accepting new patients
Internal Medicine Spec of Southern NV Grossman Panikkar Ghadishah Whi Internal Medicine CurrentSince Mar 24, 2024 Accepting new patients
Torrey Pines Rehabilitation Hospital LLC Past Accepting new patients
Royal Springs Healthcare and Rehab Inc Past Accepting new patients
Thi of Nevada II at Desert Lane, LLC Past Accepting new patients
Valley Hospital Medical Center Past Accepting new patients
St. Joseph Transitional Rehabilitation Center, LLC Past Accepting new patients
Dignity Health Past Accepting new patients

Locations

10624 S Eastern Ave
Ste A955
Henderson, NV 89052
Phone (702) 407-7700

10624 S Eastern Ave
#A955
Henderson, NV 89052
Phone (702) 407-7700

10624 S Eastern Ave
Ste A995
Henderson, NV 89052

7495 W Azure Dr
Ste 209
Las Vegas, NV 89130
Phone (702) 327-6653

201 N Buffalo Dr
Las Vegas, NV 89145
Phone (702) 242-2737

Organizations & group practices 9

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564444800000",
    "number": "1467802082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10624 S EASTERN AVE # A-955",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890522982",
            "telephone_number": "702-800-5393",
            "fax_number": "702-407-7016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10624 S EASTERN AVE # A-955",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890522982",
            "telephone_number": "702-800-5393",
            "fax_number": "702-407-7016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSSMAN",
        "first_name": "DYLLEN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-14",
        "last_updated": "2019-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "DO2474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

Verify at the official NPI Registry.