Omar Cordell Grant, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9107410 Issued in FL

Practice address

8130 Lakewood Main St Ste 103
Lakewood Ranch, FL 34202-5068

Phone

(954) 551-7041

Fax

(941) 487-0474

NPI assigned

Aug 20, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, CT2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Accountable Inpatient MedicineGroup PAC ID 5597090274, 51 clinicians

Azan Medical PAGroup PAC ID 2567684319, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Sarasota Doctors Hospital Hospital, Sarasota, FL, CCN 100166

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Accountable Inpatient Medicine

  • Internal Medicine Physician
  • Lakewood Ranch, FL
  • NPI 1659936870
  Medicare reassignment Care Compare group
• Azan Medical, PA

  • Family Medicine Physician
  • Sarasota, FL
  • NPI 1497157705
  Medicare reassignment Care Compare group
• Trinity Health of New England Provider Network Organization Inc

  • Internal Medicine Physician
  • Hartford, CT
  • NPI 1003882812
  Medicare reassignment
• Trinity Health of New England Provider Network Organization Inc

  • Internal Medicine Physician
  • Waterville, ME
  • NPI 1134779531
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sarasota Doctors Hospital Inc

  • General Acute Care Hospital
  • Sarasota, FL
  • NPI 1003862053
  Care Compare affiliation

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

{
    "created_epoch": "1376956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1831522374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8130 LAKEWOOD MAIN ST STE 103",
            "city": "LAKEWOOD RANCH",
            "state": "FL",
            "postal_code": "342025068",
            "telephone_number": "954-551-7041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8130 LAKEWOOD MAIN ST STE 103",
            "city": "LAKEWOOD RANCH",
            "state": "FL",
            "postal_code": "342025068",
            "telephone_number": "954-551-7041",
            "fax_number": "941-487-0474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "OMAR",
        "middle_name": "CORDELL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-20",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9107410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fernanda Michell Gonzalez
• Mariana Gonzalez
• Alana Gottesman
• Jemaar Graham, DPM
• Megan Graham
• Gregory Farino MD PLLC
• Tiffany M Gregory, FNP
• Elaine Marie Greifenstein, M.D.
• Michelle Delena Griffin
• Lisa Maria Griffith-Limon, DPM

• Medical Physician Assistant in Lakewood Ranch, FL
• Providers in Lakewood Ranch, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.