Individual provider Active NPI

Grayson Nathaniel Mynatt, DO

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1730757907
Registry record updated Jun 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2024031283 Issued in MO
Practice address
4025 N Sheridan Rd
Chicago, IL 60613-2010
Phone
(773) 388-1600
NPI assigned
Jun 15, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2024031283 MO Primary
Family Medicine Physician 207Q00000X 036176984 IL

Addresses

Primary practice location

4025 N Sheridan Rd
Chicago, IL 60613-2010

Mailing address

4025 N Sheridan Rd
Chicago, IL 60613-2010
Phone (773) 388-1600

Other practice location 1

551 Veterans United Dr
Columbia, MO 65201-8397
Phone (573) 884-7733

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address MUDOCREFERRAL@direct.health.missouri.edu Direct Curators of the University of Missouri

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240813002463 MO Practitioner - Family Practice 9032510557

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lincoln Mem Univ, Debusk Col of Osteopathic Med, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1 Hospital Dr
Dc032.00 Ma303
Columbia, MO 65212-0001

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.23 of 100Reported as group
Quality
58.17
Promoting interoperability
100
Improvement activities
40
Cost
75.92

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Curators of the University of Missouri Past Accepting new patients

Organizations & group practices 1

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781654400000",
    "number": "1730757907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4025 N SHERIDAN RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132010",
            "telephone_number": "773-388-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 N SHERIDAN RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132010",
            "telephone_number": "773-388-1600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "551 Veterans United Dr",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652018397",
            "country_code": "US",
            "telephone_number": "573-884-7733",
            "fax_number": "573-882-6228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MYNATT",
        "first_name": "GRAYSON",
        "middle_name": "NATHANIEL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-15",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2024031283",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036176984",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MUDOCREFERRAL@direct.health.missouri.edu",
            "affiliation": "Y",
            "endpointDescription": "Endpoint is used to receive electronic continuity of care documents (C-CDA) for outpatient referrals",
            "affiliationName": "Curators of the University of Missouri",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct",
            "address_1": "551 Veterans United Dr",
            "city": "Columbia",
            "state": "MO",
            "country_code": "US",
            "postal_code": "652018397",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.