Michael Gravina, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601005451 Issued in MI

Practice address

17330 Northland Park CT
Suite 201
Southfield, MI 48075-4318

Phone

(248) 809-2853

NPI assigned

Jul 27, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mgravina45917@direct.trinity-health.org

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.

• Iha Health Services Corporation

  • Obstetrics & Gynecology Physician
  • Canton, MI
  • NPI 1457408965
  Medicare reassignment
• St Joseph Mercy Hospital

  • Otolaryngology Physician
  • Ypsilanti, MI
  • NPI 1659499705
  Medicare reassignment
• Iha Health Service Corporation

  • Obstetrics & Gynecology Physician
  • Ypsilanti, MI
  • NPI 1831053701
  NPD
• Iha Health Services Corporation

  • Orthopaedic Surgery Physician
  • Chelsea, MI
  • NPI 1477040343
  NPD
• St Joseph Mercy Hospital

  • Cardiac Rehabilitation Clinic/Center
  • Ypsilanti, MI
  • NPI 1902359094
  NPD

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

{
    "created_epoch": "1248652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248652800000",
    "number": "1649401522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17330 NORTHLAND PARK CT",
            "address_2": "SUITE 201",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754318",
            "telephone_number": "248-809-2853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17330 NORTHLAND PARK CT",
            "address_2": "SUITE 201",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754318",
            "telephone_number": "248-809-2853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVINA",
        "first_name": "MICHAEL",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-27",
        "last_updated": "2009-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "262331509",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bradford K Grassmick, MD
• Carol J Gration, RN
• Gratus Comprehensive Home Services LLC
• Andrew Graves, LLMSW
• Nicole Graves
• Gravity Laboratories, LLC
• Breonha Gray
• Connor Gray
• Denise Gray, MD
• Emily Michelle Gray

• Physician Assistant in Southfield, MI
• Providers in Southfield, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2009; 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.

Verify at the official NPI Registry.