Michelle Grace Granstrom Macdavid, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A195577 Issued in CA

Practice address

1264 Hawks Flight CT Ste 100
El Dorado Hills, CA 95762-9354

Phone

(916) 933-4222

Fax

(916) 933-5574

NPI assigned

May 21, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Dignity Health Medical Foundation

  • Multi-Specialty Clinic/Center
  • Sacramento, CA
  • NPI 1700803418
  Medicare reassignment NPD
• Dignity Health Medical Foundation

  • Multi-Specialty Clinic/Center
  • Grass Valley, CA
  • NPI 1043456106
  NPD
• Dignity Health Medical Foundation

  • Multi-Specialty Clinic/Center
  • Redding, CA
  • NPI 1912288432
  NPD
• Dignity Health Medical Foundation

  • Multi-Specialty Clinic/Center
  • Rancho Cordova, CA
  • NPI 1568489268
  NPD (past)
• East Louisville Pediatrics, P.S.C.

  • Pediatrics Physician
  • Louisville, KY
  • NPI 1699792465
  NPD (past)
• One Pediatrics, PLLC

  • Pediatrics Physician
  • Louisville, KY
  • NPI 1063855450
  NPD (past)

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

{
    "created_epoch": "1495324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1790212751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1264 HAWKS FLIGHT CT STE 100",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957629354",
            "telephone_number": "916-933-4222",
            "fax_number": "916-933-5574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACDAVID",
        "first_name": "MICHELLE",
        "middle_name": "GRACE GRANSTROM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-21",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A195577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Lykes, LMFT
• Timothy Lyons
• M & K Shelton, Licensed Clinical Social Worker, Inc
• Kimberly Anne Mabanta
• Sarah Macchia
• Shawna Mace
• Ingrid Lorraine Mack
• Kennon Maclean
• Francine Maglionico
• Elizabeth Maidrand

• Pediatrics Physician in El Dorado Hills, CA
• Providers in El Dorado Hills, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; 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.