Individual provider Active NPI

Grainger S Lanneau Jr., MD

  • Gynecologic Oncology Physician
  • Melbourne, FL
National Provider Identifier
1801983275
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
License
ME135402 Issued in FL
Practice address
1130 S. Hickory Street Suite B
Melbourne, FL 32901-5417
Phone
(321) 725-0944
Fax
(321) 434-7590
NPI assigned
Oct 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology Physician 207VX0201X ME135402 FL Primary

Addresses

Primary practice location

1130 S. Hickory Street Suite B
Melbourne, FL 32901-5417

Mailing address

3300 S Fiske Blvd
Rockledge, FL 32955-4306

Other identifiers 2

IdentifierTypeStateIssuer
024274900MedicaidFL
JH796ZOtherFLMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20201023002089 NC Practitioner - Obstetrics/Gynecology 5294778650 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Medical College of Georgia School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

2100 Stantonsburg Rd
Greenville, NC 27834-2818
Phone (252) 847-1757

2654 M L King Jr Blvd
New Bern, NC 28562-4238
Phone (252) 637-0093

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus17

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince Oct 16, 2020 Accepting new patients

Locations

2100 Stantonsburg Rd
Greenville, NC 27834
Phone (252) 744-3229

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

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": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1801983275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 S FISKE BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 S. HICKORY STREET SUITE B",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329015417",
            "telephone_number": "321-725-0944",
            "fax_number": "321-434-7590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANNEAU",
        "first_name": "GRAINGER",
        "middle_name": "S",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "FL",
            "license": "ME135402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024274900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "JH796Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.