Carol Ann Graham, M.D.

Primary specialty

Urogynecology and Reconstructive Pelvic Surgery (Urology) PhysicianTaxonomy code 2088F0040X

License

2014036783 Issued in MO

Practice address

226 S Woods Mill Rd
Ste 55W
Chesterfield, MO 63017-3662

Phone

(314) 205-6402

Fax

(314) 590-5951

NPI assigned

Jun 9, 2005

Last updated

Mar 9, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Urogynecology Specialists of Kentuckiana

  • Gynecology Physician
  • Louisville, KY
  • NPI 1497743041
  NPD (past) Authorized official
• The University Gynecological & Obstetrical Foundation, Inc.

  • Specialist
  • Louisville, KY
  • NPI 1497700587
  NPD (past)
• University of Louisville Physicians, Inc.

  dba ULP Radiological Associates

  • Diagnostic Radiology Physician
  • Louisville, KY
  • NPI 1316294127
  NPD (past)
• University Physicians Group - Radiology

  • Diagnostic Radiology Physician
  • Louisville, KY
  • NPI 1619061116
  NPD (past)
• University Women's Care, Inc

  • Obstetrics & Gynecology Physician
  • Detroit, MI
  • NPI 1780623637
  NPD (past)

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425859200000",
    "number": "1669476370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 S WOODS MILL RD",
            "address_2": "STE 55W",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173662",
            "telephone_number": "314-205-6402",
            "fax_number": "314-590-5951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 S WOODS MILL RD",
            "address_2": "STE 55W",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173662",
            "telephone_number": "314-205-6402",
            "fax_number": "314-590-5951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "CAROL",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2015-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "KY",
            "license": "36345",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "KY",
            "license": "36345",
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "KY",
            "license": "36346",
            "primary": false
        },
        {
            "code": "2088F0040X",
            "taxonomy_group": "",
            "desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "MO",
            "license": "2014036783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200308410",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM - WOMEN'S SPECIALISTS",
            "identifier": "000000798069",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64031370",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000667083",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT - WS",
            "identifier": "50044196",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIHO - WS",
            "identifier": "142082",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dawn Renee Gorski, PTA
• Gotchurback LLC
• Derek Gould, PT
• Julie Ann Gould, D.O.
• Gpaletta Orthopedic Consulting, LLC
• Cassidy Lynn Graham, AGACNP
• Joanne L Graham, M.A., LPC
• Kailyn Marie Graham, FNP, RN
• Laquita Graham, MD
• Lisa Graham

• Urology Physician in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Urology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.