Clyde Grady

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Practice address

104 S Broad St
Knoxville, IL 61448-1339

Phone

(309) 289-2335

Fax

(309) 289-8196

NPI assigned

Oct 2, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, IA2 enrollments

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 2

Specialty

Family Practice

Education

Southern Illinois University School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeast Iowa Regional Medical Center IncGroup PAC ID 3870496417, 259 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southeast Iowa Regional Home Health Home health agency, West Burlington, IA, CCN 167136
• Southeast Iowa Regional Hospice Hospice, West Burlington, IA, CCN 161567
• Southeast Iowa Regional Medical Center Hospital, West Burlington, IA, CCN 160057
• St Mary Medical Center Hospital, Galesburg, IL, CCN 140064
• Henry County Health Center Hospital, Mount Pleasant, IA, CCN 161356
• Oakview Nursing and Rehabilitation Nursing home, Burlington, IA, CCN 165439

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• St Mary Medical Center

  dba OSF Healthcare - Medical Group - Abingdon

  • Rural Health Clinic/Center
  • Abingdon, IL
  • NPI 1750006110

  Contracted Managing Employee, Operational/Managerial Control

  CMS ownership
• St Mary Medical Center

  dba OSF Healthcare - Medical Group - Knoxville

  • Rural Health Clinic/Center
  • Knoxville, IL
  • NPI 1801512165

  Contracted Managing Employee, Operational/Managerial Control

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southeast Iowa Regional Medical Center, Inc.

  dba Southeast Iowa Regional Medical Center

  • General Practice Physician
  • West Burlington, IA
  • NPI 1164433884
  Medicare reassignment Care Compare group NPD
• Osf Healthcare System

  dba Osf Holy Family Medical Center

  • Critical Access Hospital
  • Monmouth, IL
  • NPI 1548393184
  Medicare reassignment NPD
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment NPD
• St Mary Medical Center

  dba OSF Saint Mary Medical Center

  • Emergency Medical Services (Emergency Medicine) Physician
  • Galesburg, IL
  • NPI 1962467670
  Medicare reassignment NPD
• St Mary Medical Center

  • Rural Health Clinic/Center
  • Galesburg, IL
  • NPI 1275234965
  NPD
• St Mary Medical Center

  dba OSFMG - Galesburg

  • Family Medicine Physician
  • Galesburg, IL
  • NPI 1457308710
  NPD
• Central PA Pharmacy LLC.

  dba patton pharmacy and v&s variety

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

• St Mary Medical Center

  dba OSF Saint Mary Medical Center

  • General Acute Care Hospital
  • Galesburg, IL
  • NPI 1164485363
  Care Compare affiliation
• Henry County Health Center, Inc.

  • Critical Access Hospital
  • Mt Pleasant, IA
  • NPI 1811571417
  Care Compare affiliation
• Southeast Iowa Regional Medical Center, Inc.

  dba Great River Home Health and Hospice

  • Community Based Hospice Care Agency
  • West Burlington, IA
  • NPI 1053315002
  Care Compare affiliation
• Southeast Iowa Regional Medical Center, Inc.

  dba Southeast Iowa Regional Medical Center

  • General Acute Care Hospital
  • West Burlington, IA
  • NPI 1134168263
  Care Compare affiliation
• Southeast Iowa Regional Medical Center, Inc.

  dba Great River Home Health and Hospice

  • Home Health Agency
  • West Burlington, IA
  • NPI 1760461644
  Care Compare affiliation
• The Views Operator C, LLC

  dba Blair House

  • Skilled Nursing Facility
  • Burlington, IA
  • NPI 1710431986

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851484075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 S BROAD ST",
            "city": "KNOXVILLE",
            "state": "IL",
            "postal_code": "614481339",
            "telephone_number": "309-289-2335",
            "fax_number": "309-289-8196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 S BROAD ST",
            "city": "KNOXVILLE",
            "state": "IL",
            "postal_code": "614481339",
            "telephone_number": "309-289-2335",
            "fax_number": "309-289-8196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRADY",
        "first_name": "CLYDE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East Belmont Dental
• Victoria Ann Fry
• Jinal Gala, M.S CFY-SLP
• Good Samaritan Nursing Home
• Good Samaritan Nursing Home
• Gyuchan H. Steele
• Alanna Jennings
• Knox County Nursing Home
• Michael Kotula, D.C.
• Laurianne Santos Llamanzares

• Family Medicine Physician in Knoxville, IL
• Providers in Knoxville, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.