NPIMap

Individual provider Active NPI

Kaitlyn Alger Granda, PHYSICAN ASSISTANT

  • Physician Assistant
  • Durham, NC
National Provider Identifier
1548205016
Registry record updated Sep 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
103111 Issued in NC
Practice address
1301 Fayetteville St
Durham, NC 27707-2325
Phone
(919) 956-4000
Fax
(919) 416-1285
NPI assigned
Jun 18, 2006
Last updated
Sep 14, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 103111 NC Primary

Addresses

Primary practice location

1301 Fayetteville St
Durham, NC 27707-2325

Mailing address

81 Dogwood Acres Dr
Chapel Hill, NC 27516-3111
Phone (919) 967-6462

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20140628000115 NC Practitioner - Physician Assistant 9830314103 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1301 Fayetteville St
Durham, NC 27707-2325
Phone (919) 956-4508

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
103111NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lincoln Community Health Center Incorporated CurrentSince Mar 29, 2014 Accepting new patients
Lincoln Community Health Center Incorporated CurrentSince Mar 29, 2014 Accepting new patients

Locations

1301 Fayetteville St
Durham, NC 27707
Phone (919) 956-4000

815 Broad St
Durham, NC 27705
Phone (919) 416-1254

Interoperability endpoints

  • Direct secure messaging: kgranda59186@direct.medicine.duke.edu

Organizations & group practices 2

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1548205016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 DOGWOOD ACRES DR",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275163111",
            "telephone_number": "919-967-6462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 FAYETTEVILLE ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072325",
            "telephone_number": "919-956-4000",
            "fax_number": "919-416-1285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDA",
        "first_name": "KAITLYN",
        "middle_name": "ALGER",
        "credential": "PHYSICAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-18",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.