Allen Tracy Grisson, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

K3580 Issued in TX

Practice address

1204 N Mound St
Radiology Department
Nacogdoches, TX 75961-4027

Phone

(936) 568-8514

Fax

(903) 663-0378

NPI assigned

May 12, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Radiology Consultants of Nacogdoches LLP

  • Diagnostic Radiology Physician
  • Nacogdoches, TX
  • NPI 1578512232
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324339200000",
    "number": "1700836335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5370",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756085370",
            "telephone_number": "903-663-4800",
            "fax_number": "903-663-0378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 N MOUND ST",
            "address_2": "RADIOLOGY DEPARTMENT",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614027",
            "telephone_number": "936-568-8514",
            "fax_number": "903-663-0378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISSON",
        "first_name": "ALLEN",
        "middle_name": "TRACY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2011-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "K3580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047351401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory E Hyde MD PHD PA
• Gregory P. Wittpenn, MD PA
• Kelly Michelle Griffin, SLP
• Griffith Family Medicine, PLLC
• David Grigsby, DDS
• Tyrrel C Grohman, MD
• Sabrina Guillory, CNM
• Prabhakar R Guniganti, MD
• Anne Elizabeth Gunter, MD
• Mahima Gupta

• Diagnostic Radiology Physician in Nacogdoches, TX
• Providers in Nacogdoches, TX by specialty
• Diagnostic Radiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; 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.