Individual provider Active NPI

Charles Gary Grigsby III, MD

  • Student in an Organized Health Care Education/Training Program
  • Lexington, KY
National Provider Identifier
1649809740
Registry record updated May 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
900 South Limestone CTW 304
Lexington, KY 40536-0001
Phone
(859) 323-6561
NPI assigned
Apr 2, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training ProgramGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 390200000X KY Primary

Addresses

Primary practice location

900 South Limestone CTW 304
Lexington, KY 40536-0001

Mailing address

504 Burning Tree Cir
Lexington, KY 40509-1934
Phone (859) 475-3959

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221220001858 KY Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 3779952452

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

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

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588550400000",
    "number": "1649809740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 BURNING TREE CIR",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405091934",
            "telephone_number": "859-475-3959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SOUTH LIMESTONE CTW 304",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405360001",
            "telephone_number": "859-323-6561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIGSBY",
        "first_name": "CHARLES",
        "middle_name": "GARY",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-02",
        "last_updated": "2020-05-04",
        "certification_date": "2020-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.