Active NPI
Derek Wayne Gramza
- Behavior Technician
- Ypsilanti, MI
National Provider Identifier
1629588991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- G652139866851
- Practice address
- 2610 International Dr
Ypsilanti, MI 48197-3111 - Phone
- (231) 557-5630
- NPI assigned
- Oct 2, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | G652139866851 | MI | Primary |
Addresses
Primary practice location
2610 International Dr
Ypsilanti, MI 48197-3111
Mailing address
2610 International Dr
Ypsilanti, MI 48197-3111
Phone (231) 557-5630
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AMP107347966001 | Other | MI | BLUE CROSS BLUE SHIELD |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G652139866851 | MI | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506902400000",
"number": "1629588991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2610 INTERNATIONAL DR",
"city": "YPSILANTI",
"state": "MI",
"postal_code": "481973111",
"telephone_number": "231-557-5630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2610 INTERNATIONAL DR",
"city": "YPSILANTI",
"state": "MI",
"postal_code": "481973111",
"telephone_number": "231-557-5630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAMZA",
"first_name": "DEREK",
"middle_name": "WAYNE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-10-02",
"last_updated": "2017-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Behavior Technician",
"state": "MI",
"license": "G652139866851",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "AMP107347966001",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ypsilanti, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.