Active NPI
Todd Lee Gracen, M.D.
- Internal Medicine Physician
- Charlotte, NC
National Provider Identifier
1639397904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- ME 67237
- Practice address
- 3022 Eastway Dr Ste 1-3
Charlotte, NC 28205-5642 - Phone
- (704) 251-8228
- NPI assigned
- Apr 23, 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | ME 67237 | FL | Primary |
Addresses
Primary practice location
3022 Eastway Dr Ste 1-3
Charlotte, NC 28205-5642
Mailing address
1209 Lakeside Dr
Brandon, FL 33510-4109
Phone (813) 661-3662
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 |
|---|---|---|---|
| ME 67237 | FL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountcastle Vein Center of St Petersburg | Past | Accepting new patients | |
| Wellness Works Inc | Internal Medicine | Past | Accepting new patients |
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.
-
- General Practice Physician
- St Petersburg, FL
- NPI 1619022951
-
- Internal Medicine Physician
- Brandon, FL
- NPI 1710154182
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721174400000",
"number": "1639397904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1209 LAKESIDE DR",
"city": "BRANDON",
"state": "FL",
"postal_code": "335104109",
"telephone_number": "813-661-3662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3022 EASTWAY DR STE 1-3",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282055642",
"telephone_number": "704-251-8228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRACEN",
"first_name": "TODD",
"middle_name": "LEE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-23",
"last_updated": "2024-07-17",
"certification_date": "2024-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "ME 67237",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.