Individual provider Active NPI

John Robert Grant, DC

  • Chiropractor
  • Blue Ridge, GA
National Provider Identifier
1659353951
Registry record updated Jun 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3032 Issued in GA
Practice address
2710 E First St
Blue Ridge, GA 30513-4510
Phone
(706) 632-6574
Fax
(706) 632-6527
NPI assigned
Nov 14, 2005
Last updated
Jun 28, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 28, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3032 GA Primary

Addresses

Primary practice location

2710 E First St
Blue Ridge, GA 30513-4510

Mailing address

2710 E First St
Blue Ridge, GA 30513-4510
Phone (706) 632-6574

Other identifiers 1

IdentifierTypeStateIssuer
000767335AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120725001036 GA Practitioner - Chiropractic 3870759434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grant Chiropractic of Blue Ridge, PCGroup PAC ID 8426214081, 2 clinicians

Practice addresses (Care Compare)

2710 E 1St St
Blue Ridge, GA 30513-4510
Phone (706) 632-6574

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3032GAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Grant Chiropractic of Blue Ridge, PC Chiropractor CurrentSince Jan 7, 2000 Accepting new patients

Locations

2710 E First St
Blue Ridge, GA 30513
Phone (706) 632-6574

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340841600000",
    "number": "1659353951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2710 E FIRST ST",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305134510",
            "telephone_number": "706-632-6574",
            "fax_number": "706-632-6527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 E FIRST ST",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305134510",
            "telephone_number": "706-632-6574",
            "fax_number": "706-632-6527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-14",
        "last_updated": "2012-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "3032",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000767335A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blue Ridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.