NPIMap

Individual provider Active NPI

Kristen Elaine Grant, PAC

  • Physician Assistant
  • Tallmadge, OH
National Provider Identifier
1851322242
Registry record updated Dec 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.2875 Issued in OH
Practice address
145 West Ave
Tallmadge, OH 44278-2250
Phone
(330) 633-8341
Fax
(330) 633-8462
NPI assigned
Jul 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1805 MA
Physician Assistant 363A00000X 50.2875 OH Primary

Addresses

Primary practice location

145 West Ave
Tallmadge, OH 44278-2250

Mailing address

145 West Ave
Tallmadge, OH 44278-2250
Phone (330) 633-8341

Other identifiers 1

IdentifierTypeStateIssuer
9768939MedicaidMA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kristengrant@uhps.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130522000673 OH Practitioner - Physician Assistant 5092756353 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

145 W Ave
Tallmadge, OH 44278-2250
Phone (330) 633-8341

158 W Main Rd
Conneaut, OH 44030-2039

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.15 of 100Reported as apm
Quality
82.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1805MAMDPhysician Assistant
50.2875OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Primary Care Practices Inc CurrentSince Aug 1, 2018 Accepting new patients
University Primary Care Practices Inc CurrentSince Aug 1, 2018 Accepting new patients
University Hospitals Medical Group Inc Past Accepting new patients
Sami Abdel Sayed Raphael Inc Past Accepting new patients

Locations

158 W Main Rd
Ste 203
Conneaut, OH 44030
Phone (440) 285-2960

145 West Ave
Tallmadge, OH 44278
Phone (330) 633-7090

Interoperability endpoints

  • Direct secure messaging: kgrant28401@ehrdirect.uhhospitals.org

Organizations & group practices 5

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 3

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1851322242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 WEST AVE",
            "city": "TALLMADGE",
            "state": "OH",
            "postal_code": "442782250",
            "telephone_number": "330-633-8341",
            "fax_number": "330-633-8462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 WEST AVE",
            "city": "TALLMADGE",
            "state": "OH",
            "postal_code": "442782250",
            "telephone_number": "330-633-8341",
            "fax_number": "330-633-8462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "KRISTEN",
        "middle_name": "ELAINE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "1805",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.2875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9768939",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kristengrant@uhps.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "145 West Ave",
            "city": "Tallmadge",
            "state": "OH",
            "country_code": "US",
            "postal_code": "442782250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tallmadge, OH

Sources for this page

Verify at the official NPI Registry.