Gordon L Grenn

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS0003345 Issued in FL

Practice address

4002 Raulerson Dr
Lake Worth, FL 33463-8927

Phone

(561) 964-4077

Fax

(561) 964-9296

NPI assigned

Aug 30, 2006

Last updated

Jun 10, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Family Practice

Education

Other, 1970

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Vitas Healthcare Corporation of Florida Hospice, Melbourne, FL, CCN 101545
• Pine Trail Nursing and Rehab Center Nursing home, Lake Worth, FL, CCN 105835

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gordon Grenn D.O., P.a.

  • Family Medicine Physician
  • Lake Worth, FL
  • NPI 1326348681
  Medicare reassignment NPD Authorized official
• Independent Imaging, LLC

  • Radiology Clinic/Center
  • Fort Lauderdale, FL
  • NPI 1013908912
  Medicare reassignment NPD
• Palms West Imaging Inc

  dba Palms West Open MRI - RPB

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Royal Palm Beach, FL
  • NPI 1700877602
  NPD (past)
• Palms West MRI, LLC

  • Radiology Clinic/Center
  • Belle Glade, FL
  • NPI 1871584771
  NPD (past)

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

• Lake Worth Opco LLC

  • Skilled Nursing Facility
  • Lake Worth, FL
  • NPI 1730965500

  Nursing home

  Care Compare affiliation
• Vitas Healthcare Corporation of Florida

  • Community Based Hospice Care Agency
  • Boynton Beach, FL
  • NPI 1467507657
  Care Compare affiliation
• Vitas Healthcare Corporation of Florida

  • Community Based Hospice Care Agency
  • Miami Lakes, FL
  • NPI 1528113792
  Care Compare affiliation
• Vitas Healthcare Corporation of Florida

  • Community Based Hospice Care Agency
  • Melbourne, FL
  • NPI 1669548053
  Care Compare affiliation
• Vitas Healthcare Corporation of Florida

  • Community Based Hospice Care Agency
  • Tallahassee, FL
  • NPI 1972555464
  Care Compare affiliation

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307664000000",
    "number": "1871603670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4002 RAULERSON ROAD",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334638927",
            "telephone_number": "561-964-4077",
            "fax_number": "561-964-9296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4002 RAULERSON DR",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334638927",
            "telephone_number": "561-964-4077",
            "fax_number": "561-964-9296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRENN",
        "first_name": "GORDON",
        "middle_name": "L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2011-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS0003345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265885200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas Todd Greco
• Green Tree Home Health LLC.
• Greenacres Chiropractic Group
• Mallory Alexis Greenberg
• James L Gregalot, DDS
• Nichole Grim
• Tyler Grinstead
• Lenoska Grose, PTA
• Greisy Grueiro Garcia
• Guadalupe Medical Center Inc

• Family Medicine Physician in Lake Worth, FL
• Providers in Lake Worth, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2011; 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.