Active NPI
Michael K. Grugan, PA
- Surgical Physician Assistant
- Schenectady, NY
National Provider Identifier
1811915903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 000486
- Practice address
- 1101 Nott St
Schenectady, NY 12308-2425 - Phone
- (518) 243-4000
- NPI assigned
- Jul 17, 2006
- 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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 000486 | NY | Primary |
Addresses
Primary practice location
1101 Nott St
Schenectady, NY 12308-2425
Mailing address
1462 Erie Blvd
Suite 2
Schenectady, NY 12305-1026
Phone (518) 243-1500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000406504002 | Other | NY | BLUE SHIELD |
| 040426006788 | Other | NY | FIDELIS CARE |
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)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184371200000",
"number": "1811915903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1462 ERIE BLVD",
"address_2": "SUITE 2",
"city": "SCHENECTADY",
"state": "NY",
"postal_code": "123051026",
"telephone_number": "518-243-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 NOTT ST",
"city": "SCHENECTADY",
"state": "NY",
"postal_code": "123082425",
"telephone_number": "518-243-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRUGAN",
"first_name": "MICHAEL",
"middle_name": "K.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2007-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NY",
"license": "000486",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "000406504002",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIDELIS CARE",
"identifier": "040426006788",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Schenectady, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.