Grant Aloysius Powderly, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2024019734 Issued in MO

Practice address

1780 Old Highway 50 E
Union, MO 63084-3219

Phone

(844) 853-8937

NPI assigned

Jun 3, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Compass Health, Inc

  • Community/Behavioral Health Agency
  • Clinton, MO
  • NPI 1285619494
  Medicare reassignment NPD
• Compass Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Rolla, MO
  • NPI 1558258632
  NPD

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

{
    "created_epoch": "1717372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1700627973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 COMMUNITY",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647358804",
            "telephone_number": "844-853-8937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1780 OLD HIGHWAY 50 E",
            "city": "UNION",
            "state": "MO",
            "postal_code": "630843219",
            "telephone_number": "844-853-8937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWDERLY",
        "first_name": "GRANT",
        "middle_name": "ALOYSIUS",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-03",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2024019734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Picha, LPC
• Maria Polacek, LPC
• Megan L Porta, LPC
• Holly Porter, LPC
• Kristine Marie Posinski
• Preferred Family Healthcare
• Larissa Chandrima Kaiulani Proctor, LPC
• Megan N Pruett, MA LPC
• Lindsey Marie Rahe
• Rainbow Abilities Center, Inc.

• General Practice Dentistry in Union, MO
• Providers in Union, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.