NPIMap

Individual provider Active NPI

Marc B Grant, DO

  • Pain Medicine (Anesthesiology) Physician
  • Payson, AZ
National Provider Identifier
1700857125
Registry record updated Sep 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
1609 Issued in AZ
Practice address
708 S Coeur D Alene LN
Payson, AZ 85541-5662
Phone
(928) 468-1337
Fax
(928) 468-1339
NPI assigned
Feb 1, 2006
Last updated
Sep 15, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X 1609 AZ Primary

Addresses

Primary practice location

708 S Coeur D Alene LN
Payson, AZ 85541-5662

Mailing address

708 S Coeur D Alene LN
Payson, AZ 85541-5662
Phone (928) 468-1337

Other identifiers 2

IdentifierTypeStateIssuer
H20777190OtherAZBXBS
285280MedicaidAZ

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 Osteopathy

State licenses

LicenseStateTypeSpecialty
1609AZMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Marc B Grant DO PC PastSince Mar 18, 2005 Accepting new patients
Cochise Group Anesthesia Services, LLC Past Accepting new patients
Carefree Pain Clinic LLC Past Accepting new patients
Next Level Facility LLC PastSince Nov 12, 2023 Accepting new patients
Arizona Pain Physicians, LLC Past Accepting new patients
Peoria Pain Physicians PastSince Jan 2, 2018 Accepting new patients
Robert S. Gerson MD PC Past Accepting new patients
Foothills Chiropractic Clinic, PC Past Accepting new patients

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347667200000",
    "number": "1700857125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 S COEUR D ALENE LN",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415662",
            "telephone_number": "928-468-1337",
            "fax_number": "928-468-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 S COEUR D ALENE LN",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415662",
            "telephone_number": "928-468-1337",
            "fax_number": "928-468-1339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "MARC",
        "middle_name": "B",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-01",
        "last_updated": "2012-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "AZ",
            "license": "1609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BXBS",
            "identifier": "H20777190",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "285280",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Payson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.