Gustavo Granada, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2001023407 Issued in MO

Practice address

600 E Dixie Ave
Leesburg, FL 34748-5925

Phone

(352) 323-5467

NPI assigned

Aug 11, 2006

Last updated

Jan 30, 2026By 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 2

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

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Leesburg Regional Medical Center Physician Services LLC

  • Emergency Medicine Physician
  • Leesburg, FL
  • NPI 1104063114
  Medicare reassignment NPD
• Paragon Contracting Services LLC

  • Emergency Medicine Physician
  • Birmingham, AL
  • NPI 1225071459

  FL

  Medicare reassignment NPD
• Acs Primary Care Physicians - Southeast PC

  • Emergency Medicine Physician
  • Myrtle Beach, SC
  • NPI 1861430555
  NPD (past)
• Southeast Missouri Health Network

  • Federally Qualified Health Center (FQHC)
  • Sikeston, MO
  • NPI 1104045475
  NPD (past)
• Southeast Missouri Health Network

  dba Southeast Health on Wheels Mobile Van

  • Federally Qualified Health Center (FQHC)
  • Malden, MO
  • NPI 1720209794
  NPD (past)
• Twin Rivers Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Kennett, MO
  • NPI 1184668907
  NPD (past)

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769731200000",
    "number": "1881605137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100186",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100186",
            "telephone_number": "352-265-5911",
            "fax_number": "352-265-5606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E DIXIE AVE",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485925",
            "telephone_number": "352-323-5467"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "807 South Byp",
            "address_purpose": "LOCATION",
            "city": "Kennett",
            "state": "MO",
            "postal_code": "638573244",
            "country_code": "US",
            "telephone_number": "573-717-1332",
            "fax_number": "573-717-1335",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17021 US Highway 441",
            "address_purpose": "LOCATION",
            "city": "Mount Dora",
            "state": "FL",
            "postal_code": "327576734",
            "country_code": "US",
            "telephone_number": "352-720-7999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRANADA",
        "first_name": "GUSTAVO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2001023407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121357800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205799208",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin Dewaila Gordon, DBH, LSSYB, RMHCI
• Candy L Gott
• Shelly Nichole Grabiak, LCSW
• Denise Graham
• Stephen Z. Grahovac, MD
• Greatest Minds Support Services
• Victoria Catherine Greenwell
• Patricia A Gregg, MD
• Karen Marie Gresens, COTA/L
• Angela Griffiths, LPN

• Internal Medicine Physician in Leesburg, FL
• Providers in Leesburg, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2026; 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.