Michael David Gross, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9101248 Issued in FL

Practice address

400 Avenue K SE
Suite 11
Winter Haven, FL 33880-4146

Phone

(863) 294-4404

Fax

(863) 294-1059

NPI assigned

Feb 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• University of Florida Jacksonville Physicians, Inc.

  • Family Medicine Physician
  • Yulee, FL
  • NPI 1518126168
  NPD (past)

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333065600000",
    "number": "1891760427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 AVENUE K, SE",
            "address_2": "SUITE 11",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338804145",
            "telephone_number": "863-294-4404",
            "fax_number": "863-294-1059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 AVENUE K SE",
            "address_2": "SUITE 11",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338804146",
            "telephone_number": "863-294-4404",
            "fax_number": "863-294-1059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSS",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2012-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "003304",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9101248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002229B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2907941-00",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970021690",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela Regina Griffin, ARNP
• Gerald W. Griner, DDS
• Deborah Grinker
• Laqueisha Groover
• Shakiera Groover
• Donna Therese Grosser, LMHC
• Cheryl Williams Grothmann, PMHNP-BC
• Lindsey Ann Grych, APRN
• Khloe Yinyin Gu, DO
• Guardian Adult Home Care

• Medical Physician Assistant in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.