Active NPI
Richard George Grassy, MD
- Pediatrics Physician
- Mahomet, IL
National Provider Identifier
1811054828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 16546-020
- Practice address
- 2408 Walden Woods CT
Mahomet, IL 61853-7412 - Phone
- (217) 586-1859
- NPI assigned
- Jan 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 16546-020 | WI | Primary |
| Pediatrics Physician | 208000000X | 5253 | ND |
Addresses
Primary practice location
2408 Walden Woods CT
Mahomet, IL 61853-7412
Mailing address
2408 Walden Woods CT
Mahomet, IL 61853-7412
Phone (217) 586-1859
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5253 | ND | MD | Pediatrics Physician |
| 16546-020 | WI | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355875200000",
"number": "1811054828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2408 WALDEN WOODS CT",
"city": "MAHOMET",
"state": "IL",
"postal_code": "618537412",
"telephone_number": "217-586-1859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2408 WALDEN WOODS CT",
"city": "MAHOMET",
"state": "IL",
"postal_code": "618537412",
"telephone_number": "217-586-1859"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRASSY",
"first_name": "RICHARD",
"middle_name": "GEORGE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-02",
"last_updated": "2012-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WI",
"license": "16546-020",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "ND",
"license": "5253",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mahomet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.