Active NPI
Glynn Adam Granger, MD
- Surgery Physician
- Opelousas, LA
National Provider Identifier
1629069034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 011393
- Practice address
- 3975 I 49 S Service Rd
Suite 105
Opelousas, LA 70570-0775 - Phone
- (337) 948-7680
- Fax
- (337) 948-1143
- NPI assigned
- Nov 3, 2005
- Last updated
- Nov 2, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 011393 | LA | Primary |
Addresses
Primary practice location
3975 I 49 S Service Rd
Suite 105
Opelousas, LA 70570-0775
Mailing address
3975 I 49 S Service Rd
Suite 105
Opelousas, LA 70570-0775
Phone (337) 948-7680
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134643 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011393 | LA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Acadiana Surgical Clinic Inc | Surgery | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Surgery Physician
- Opelousas, LA
- NPI 1821089665
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193961600000",
"number": "1629069034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3975 I 49 S SERVICE RD",
"address_2": "SUITE 105",
"city": "OPELOUSAS",
"state": "LA",
"postal_code": "705700775",
"telephone_number": "337-948-7680",
"fax_number": "337-948-1143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3975 I 49 S SERVICE RD",
"address_2": "SUITE 105",
"city": "OPELOUSAS",
"state": "LA",
"postal_code": "705700775",
"telephone_number": "337-948-7680",
"fax_number": "337-948-1143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANGER",
"first_name": "GLYNN",
"middle_name": "ADAM",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-03",
"last_updated": "2007-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "LA",
"license": "011393",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1134643",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Opelousas, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; 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.