Grace Pedersen, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

ARNP1617512 Issued in FL

Practice address

1211 Dunlawton Ave
Port Orange, FL 32127-2913

Phone

(386) 675-4411

Fax

(386) 675-4419

NPI assigned

Apr 22, 2010

Last updated

Apr 22, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1579/brand/8/csg/141/fhir/r4

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.

• Ormond Medical Arts Family Practice LLC

  dba Complete Health

  • Family Medicine Physician
  • Ormond Beach, FL
  • NPI 1326254962
  Medicare reassignment NPD
• Metcare of Florida, Inc

  dba Conviva Care Center

  • Internal Medicine Physician
  • Hialeah, FL
  • NPI 1902893225
  NPD (past)
• Mobile Medical Industries Inc

  dba AllianceCare

  • Primary Care Nurse Practitioner
  • Boynton Beach, FL
  • NPI 1528019247
  NPD (past)

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

{
    "created_epoch": "1271894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271894400000",
    "number": "1528385176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 DUNLAWTON AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321272913",
            "telephone_number": "386-675-4411",
            "fax_number": "386-675-4419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 DUNLAWTON AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321272913",
            "telephone_number": "386-675-4411",
            "fax_number": "386-675-4419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "GRACE",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-22",
        "last_updated": "2010-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP1617512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Raymond Peacock III, RBT
• Stephanie Alyce Peacock, HAS
• Andrea J Pearson
• Joseph Pecchio, LMHC REGISERED INTER
• Margaret Leigh Ann Peck, ARNP, FNP-BC
• Jill Marie Pedersen
• Kristie Peltier
• Sharon S Pendergrass, RPH
• Robert Clark Pennell, PHD
• Aleah Pennisi

• Family Nurse Practitioner in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.