Active NPI
Gaither D. Bynum, M.D.
- Internal Medicine Physician
- Grand Junction, CO
National Provider Identifier
1619940459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 44569
- Practice address
- 2635 N 7TH St Ste 4205
Grand Junction, CO 81501-8209 - Phone
- (970) 298-7049
- Fax
- (970) 298-2079
- NPI assigned
- Feb 10, 2006
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 45316 | WI | |
| Internal Medicine Physician | 207R00000X | 44569 | CO | Primary |
Addresses
Primary practice location
2635 N 7TH St Ste 4205
Grand Junction, CO 81501-8209
Mailing address
2635 N 7TH St Ste 4205
PO Box 62
Grand Junction, CO 81501-8209
Phone (970) 298-7049
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 66835216 | Medicaid | CO | |
| 34471400 | Medicaid | WI |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44569 | CO | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prohealth Medical Group Inc | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389139200000",
"number": "1619940459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2635 N 7TH ST STE 4205",
"address_2": "PO BOX 62",
"city": "GRAND JUNCTION",
"state": "CO",
"postal_code": "815018209",
"telephone_number": "970-298-7049",
"fax_number": "970-298-2079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2635 N 7TH ST STE 4205",
"city": "GRAND JUNCTION",
"state": "CO",
"postal_code": "815018209",
"telephone_number": "970-298-7049",
"fax_number": "970-298-2079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BYNUM",
"first_name": "GAITHER",
"middle_name": "D.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-10",
"last_updated": "2014-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WI",
"license": "45316",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CO",
"license": "44569",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "66835216",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "34471400",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Junction, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.