Active NPI
Rory Tynan Grace, M.D.
- Gastroenterology Physician
- Raleigh, NC
National Provider Identifier
1649680778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 2021-01504
- Practice address
- 4420 Lake Boone TRL
Raleigh, NC 27607-7505 - Phone
- (919) 784-5050
- NPI assigned
- Apr 28, 2014
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | 25MA10113900 | NJ | |
| Internal Medicine Physician | 207R00000X | MT205831 | PA | |
| Gastroenterology Physician | 207RG0100X | 2021-01504 | NC | Primary |
Addresses
Primary practice location
4420 Lake Boone TRL
Raleigh, NC 27607-7505
Mailing address
4420 Lake Boone TRL
Raleigh, NC 27607-7505
Phone (919) 784-5050
Other practice location 1
1 Cooper Plz
Camden, NJ 08103-1461
Phone (856) 342-2000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rgrace700066@direct.UNC.nchie.net | Direct |
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 |
|---|---|---|---|
| MT205831 | PA | MD | Internal Medicine Physician |
| 2021-01504 | NC | MD | Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rex Hospital Inc | 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.
-
- Cardiovascular Disease Physician
- Raleigh, NC
- NPI 1972939643
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624924800000",
"number": "1649680778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4420 LAKE BOONE TRL",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276077505",
"telephone_number": "919-784-5050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4420 LAKE BOONE TRL",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276077505",
"telephone_number": "919-784-5050"
}
],
"practiceLocations": [
{
"address_1": "1 Cooper Plz",
"address_purpose": "LOCATION",
"city": "Camden",
"state": "NJ",
"postal_code": "081031461",
"country_code": "US",
"telephone_number": "856-342-2000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GRACE",
"first_name": "RORY",
"middle_name": "TYNAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-04-28",
"last_updated": "2021-06-29",
"certification_date": "2021-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "NJ",
"license": "25MA10113900",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "MT205831",
"primary": false
},
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "NC",
"license": "2021-01504",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rgrace700066@direct.UNC.nchie.net",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/CCD/TXT",
"address_1": "4420 Lake Boone Trl",
"city": "Raleigh",
"state": "NC",
"country_code": "US",
"postal_code": "276077505",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; 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.