NPIMap

Individual provider Active NPI

Anthony Peter Grello Jr., MD

  • Emergency Medicine Physician
  • Fayetteville, NC
National Provider Identifier
1679574032
Registry record updated May 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
200500570 Issued in NC
Practice address
1638 Owen Dr
Fayetteville, NC 28304-3424
Phone
(910) 609-6350
NPI assigned
Aug 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 200500570 NC Primary

Addresses

Primary practice location

1638 Owen Dr
Fayetteville, NC 28304-3424

Mailing address

PO Box 1070
Charlotte, NC 28201-1070
Phone (800) 476-8646

Other identifiers 2

IdentifierTypeStateIssuer
5901468MedicaidNC
1397JOtherNCBCBSNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050830000580 NC Practitioner - Emergency Medicine 3870524796 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Philadelphia College of Osteopathic Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cfvhs Ed PhysiciansGroup PAC ID 2961316237, 27 clinicians

Practice addresses (Care Compare)

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 615-8780

Hospital & facility affiliations

  • Cape Fear Valley Medical Center Hospital, Fayetteville, NC, CCN 340028

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200500570NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cfvhs Ed Physicians Emergency Medicine CurrentSince Sep 1, 2005 Accepting new patients
Cumberland County Hospital System Inc CurrentSince Dec 3, 2014 Accepting new patients
Cumberland County Hospital System Inc Current Accepting new patients
Cumberland County Hospital System Inc CurrentSince Dec 3, 2014 Accepting new patients
Cfvhs Ed Physicians Emergency Medicine CurrentSince Sep 1, 2005 Accepting new patients

Locations

150 Robeson St
Fayetteville, NC 28301
Phone (910) 609-1000

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

6387 Ramsey St
Unit 100
Fayetteville, NC 28311
Phone (910) 615-3879

300 Medical Pavilion Dr
#25
Raeford, NC 28376
Phone (910) 904-8035

Organizations & group practices 5

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367452800000",
    "number": "1679574032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1070",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282011070",
            "telephone_number": "800-476-8646",
            "fax_number": "919-382-3210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1638 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043424",
            "telephone_number": "910-609-6350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRELLO",
        "first_name": "ANTHONY",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2013-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "200500570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901468",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "1397J",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.