Active NPI
Michael H Gremillion, MHPS / RSPS
- Peer Specialist
- Killeen, TX
National Provider Identifier
1689395212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 1533-11
- Practice address
- 4312 Matt Dr
Killeen, TX 76549-4779 - Phone
- (409) 466-9888
- NPI assigned
- Sep 12, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 1533-11 | TX | Primary |
Addresses
Primary practice location
4312 Matt Dr
Killeen, TX 76549-4779
Mailing address
PO Box 690914
Killeen, TX 76549-0016
Phone (409) 466-9888
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50363-0122 | Other | TX | TEXAS CERTIFICATION BOARD OF ADDICTION PROFESSIONALS |
| 1533-1121 | Other | TX | TEXAS CERTIFICATION BOARD OF ADDICTION PROFESSIONALS |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | 4mytransition.com | Direct |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1533-11 | TX | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662940800000",
"number": "1689395212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 690914",
"city": "KILLEEN",
"state": "TX",
"postal_code": "765490016",
"telephone_number": "409-466-9888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4312 MATT DR",
"city": "KILLEEN",
"state": "TX",
"postal_code": "765494779",
"telephone_number": "409-466-9888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREMILLION",
"first_name": "MICHAEL",
"middle_name": "H",
"credential": "MHPS / RSPS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-09-12",
"last_updated": "2022-09-12",
"certification_date": "2022-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "TX",
"license": "1533-11",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS CERTIFICATION BOARD OF ADDICTION PROFESSIONALS",
"identifier": "50363-0122",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS CERTIFICATION BOARD OF ADDICTION PROFESSIONALS",
"identifier": "1533-1121",
"state": "TX"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "4mytransition.com",
"affiliation": "N",
"endpointDescription": "Secure link will be provided for seneitive information",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Application guidance",
"address_1": "4312 Matt Dr",
"city": "Killeen",
"state": "TX",
"country_code": "US",
"postal_code": "765494779",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Killeen, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.