Antonio M Granda, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

MD23009 Issued in ME

Practice address

46 Fairview Ave Ste 221
Skowhegan, ME 04976-1481

Phone

(207) 474-6945

Fax

(207) 474-6933

NPI assigned

Jun 7, 2006

Last updated

Nov 4, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 13

Medicare fee-for-service enrollment

Enrolled in TN, GA, DE, IL, ND, SC6 enrollments

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 6

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: agranda@yourcarecommunity.org
• Direct secure messaging: agrandamd421376@carlehiedirect.net
• Direct secure messaging: antonio.granda.1@27782.direct.athenahealth.com
• Direct secure messaging: antonio.granda.1@8478.direct.athenahealth.com

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.

• Carle Health Medical Group

  dba Carle Physician Group

  • Internal Medicine Physician
  • Urbana, IL
  • NPI 1154653947
  Medicare reassignment NPD
• Deaconess Illinois Specialty Clinic, Inc.

  dba Deaconess IL Specialty 3331 DeYoung

  • Surgery Physician
  • Marion, IL
  • NPI 1972210235

  Internal Medicine

  Medicare reassignment NPD
• Georgetown Physician Associates, LLC

  dba Tidelands Health Family Medicine

  • Family Medicine Physician
  • Murrells Inlet, SC
  • NPI 1235475930
  Medicare reassignment NPD
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment NPD
• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  Medicare reassignment NPD
• Phoebe Putney Memorial Hospital Inc

  dba Phoebe Putney Memorial Hosptial

  • General Acute Care Hospital
  • Albany, GA
  • NPI 1992789721
  Medicare reassignment NPD
• Sanford Bismarck

  dba Family Wellness

  • Multi-Specialty Clinic/Center
  • Bismarck, ND
  • NPI 1811941172
  Medicare reassignment NPD
• Sumner Physician Practices LLC

  dba HighPoint Endocrinology Associates

  • Endocrinology, Diabetes & Metabolism Physician
  • Gallatin, TN
  • NPI 1720572209
  Medicare reassignment NPD
• Tidalhealth Physician Network, Inc.

  • Family Medicine Physician
  • Seaford, DE
  • NPI 1467534636
  Medicare reassignment NPD
• Central PA Pharmacy LLC.

  dba patton pharmacy and v&s variety

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Deaconess Illinois Specialty Clinic, Inc.

  dba Deaconess IL Specialty 4117 Water Tower

  • Family Medicine Physician
  • Mount Vernon, IL
  • NPI 1003523374
  NPD
• Deaconess Illinois Specialty Clinic, Inc.

  dba Deaconess Care Group Illinois Union County

  • Hospitalist Physician
  • Anna, IL
  • NPI 1225858251
  NPD

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1780624023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 468",
            "city": "SKOWHEGAN",
            "state": "ME",
            "postal_code": "049760468",
            "telephone_number": "207-858-8353",
            "fax_number": "207-474-9261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 FAIRVIEW AVE STE 221",
            "city": "SKOWHEGAN",
            "state": "ME",
            "postal_code": "049761481",
            "telephone_number": "207-474-6945",
            "fax_number": "207-474-6933"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4230 Harding Rd",
            "address_2": "Suite 400",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372052013",
            "country_code": "US",
            "telephone_number": "615-297-2700",
            "fax_number": "615-269-4584",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10600 Montgomery Rd",
            "address_purpose": "LOCATION",
            "city": "Montgomery",
            "state": "OH",
            "postal_code": "452424463",
            "country_code": "US",
            "telephone_number": "513-794-5600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRANDA",
        "first_name": "ANTONIO",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "09565",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OH",
            "license": "35.143494",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TN",
            "license": "9565",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "ME",
            "license": "MD23009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1416751",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64746449",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "104697",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1507235",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "USA - MCO",
            "identifier": "378643",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4066743",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "100014907",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN/PHCS",
            "identifier": "12079645",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF TN",
            "identifier": "3164315",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY/FIRST HEALTH",
            "identifier": "1629728",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP TNCARE AND AMERIVANTAGE MCR ADVANTAGE",
            "identifier": "10074063",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "USA PPO/GEHA",
            "identifier": "1100315241",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q006396",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michaela Goomishian, OTR/L
• Priscilla M Gosselin Rice, LCSW, LADC, CCS, SAP
• Abhishekh Satyanand Govind, M.D.
• Lyn Govoni, M.S., CCC-SLP
• Jessica L Graf, P.T.A.
• Rachel Lee Grant, LSW
• Kim Grondin, LMT
• Laura Gurenlian, DO
• Deborah Henderson Gurney, LSW
• Hannaford Bros Co LLC (Hannaford Food and Drug)

• Gastroenterology Physician in Skowhegan, ME
• Providers in Skowhegan, ME by specialty
• Gastroenterology Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; 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.