Active NPI
Gregory Raiss
- Diagnostic Radiology Physician
- Troy, MI
National Provider Identifier
1740240373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 4301042460
- Practice address
- 44201 Dequindre Rd
Troy, MI 48085-1117 - Phone
- (248) 964-5190
- NPI assigned
- Mar 27, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 4301042460 | MI | Primary |
Addresses
Primary practice location
44201 Dequindre Rd
Troy, MI 48085-1117
Mailing address
130 Town Center Dr
Ste 203
Troy, MI 48084-1744
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1577400 | Medicaid | MI | |
| 300F362480 | Other | MI | BCBSM |
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 Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beaumont Special Radiological Procedures | Diagnostic Radiology | 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.
-
- Diagnostic Radiology Physician
- Royal Oak, MI
- NPI 1043220205
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516665600000",
"number": "1740240373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 TOWN CENTER DR",
"address_2": "STE 203",
"city": "TROY",
"state": "MI",
"postal_code": "480841744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44201 DEQUINDRE RD",
"city": "TROY",
"state": "MI",
"postal_code": "480851117",
"telephone_number": "248-964-5190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAISS",
"first_name": "GREGORY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-27",
"last_updated": "2018-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MI",
"license": "4301042460",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1577400",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "300F362480",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.