Scott Fitzgerald Graham, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301106753 Issued in MI

Practice address

1175 Wilson Ave NW
Walker, MI 49534-6407

Phone

(616) 685-8650

NPI assigned

Mar 23, 2006

Last updated

May 14, 2021By 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 FL

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: scott.graham@ckl.eclinicaldirectplus.com

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.

• Carlos a Labrador Mdpa

  • Family Medicine Physician
  • St Petersburg, FL
  • NPI 1376753350
  Medicare reassignment NPD
• Bayfront Enterprises Inc

  dba Bayfront Convenient Care Clinics

  • Urgent Care Clinic/Center
  • St Petersburg, FL
  • NPI 1710963236
  NPD (past)
• Suncoast Medical Clinic LLC

  • Multi-Specialty Clinic/Center
  • St Petersburg, FL
  • NPI 1497866537
  NPD (past)

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620950400000",
    "number": "1861452104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6775 CROSSWINDS DR N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337105471",
            "telephone_number": "727-381-8006",
            "fax_number": "727-381-9629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 WILSON AVE NW",
            "city": "WALKER",
            "state": "MI",
            "postal_code": "495346407",
            "telephone_number": "616-685-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "SCOTT",
        "middle_name": "FITZGERALD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301106753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Frank
• David Wayne Gantz, LMSW
• Christina Marie Gifford, BCBA
• Susan Lynn Gill, LMSW, ACSW
• Anne Marie Glass, R.N.
• Denise Cecelia Griggs, LMSW
• Gro Optical, LLC (G.R.O. Optical)
• Brooklyn Haisma
• Amy Hall, PHARMD
• Jaime Halverson, DO

• Family Medicine Physician in Walker, MI
• Providers in Walker, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.