Active NPI
Radonis Grissom, DO
- Surgery Physician
- Omaha, NE
National Provider Identifier
1770370199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 10371
- Practice address
- 7500 Mercy Rd
Omaha, NE 68124-2319 - Phone
- (402) 280-2709
- NPI assigned
- Apr 21, 2025
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 10371 | NE | Primary |
Addresses
Primary practice location
7500 Mercy Rd
Omaha, NE 68124-2319
Mailing address
7710 Mercy Rd Ste 202
Omaha, NE 68124-2353
Phone (402) 280-2709
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250710004266 | NE | Order and Referring Only - General Surgery | 6406361302 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10371 | NE | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1745193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751673600000",
"number": "1770370199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7710 MERCY RD STE 202",
"city": "OMAHA",
"state": "NE",
"postal_code": "681242353",
"telephone_number": "402-280-2709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7500 MERCY RD",
"city": "OMAHA",
"state": "NE",
"postal_code": "681242319",
"telephone_number": "402-280-2709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRISSOM",
"first_name": "RADONIS",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-04-21",
"last_updated": "2025-07-05",
"certification_date": "2025-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NE",
"license": "10371",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2025; 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.