Active NPI
Clarice Grandpre, M.D.
- Family Medicine Physician
- Fairbanks, AK
National Provider Identifier
1679548002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2983
- Practice address
- 995 Ellesmere Dr
Fairbanks, AK 99709-5759 - Phone
- (907) 479-8101
- NPI assigned
- Feb 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2983 | AK | Primary |
Addresses
Primary practice location
995 Ellesmere Dr
Fairbanks, AK 99709-5759
Mailing address
PO Box 84945
Fairbanks, AK 99708-4945
Phone (907) 374-4463
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD0102 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2983 | AK | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566950400000",
"number": "1679548002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 84945",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997084945",
"telephone_number": "907-374-4463",
"fax_number": "907-374-7072"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "995 ELLESMERE DR",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997095759",
"telephone_number": "907-479-8101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANDPRE",
"first_name": "CLARICE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-20",
"last_updated": "2019-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AK",
"license": "2983",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "MD0102",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.