Active NPI
Michael L Gross, DMD
- General Practice Dentistry
- Cadiz, KY
National Provider Identifier
1891849295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- KENTUCKY5297
- Practice address
- 51 South Road
Cadiz, KY 42211-1747 - Phone
- (270) 522-3484
- Fax
- (270) 522-4662
- NPI assigned
- Jan 22, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | KENTUCKY5297 | KY | Primary |
Addresses
Primary practice location
51 South Road
Cadiz, KY 42211-1747
Mailing address
51 South Road
PO Box 1747
Cadiz, KY 42211-1747
Phone (270) 522-3484
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60052974 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160202001519 | KY | Order and Referring Only - Maxillofacial Surgery | 0244284701 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KENTUCKY5297 | KY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trigg County Hospital, Inc | Past | Accepting new patients |
Ownership & related parties
All facility ownership & control disclosures 4
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Trigg County Hospital, Inc | Hospital | Corporate Officer | Nov 1, 2007 |
| Trigg County Hospital, Inc | Hospital | Corporate Officer Corporate Director |
Dec 21, 1999 Dec 21, 1999 |
| Trigg County Primary Care | Rural health clinic | Corporate Officer | Sep 14, 2014 |
| Main Street Rural Health Clinic | Rural health clinic | Corporate Director | Oct 4, 2010 |
Owned or controlled facilities with NPI records 4
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Medicare Defined Swing Bed Hospital Unit
- Cadiz, KY
- NPI 1932230497
Corporate Director, Corporate Officer
Organizations & group practices 1
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.
-
- Rural Health Clinic/Center
- Cadiz, KY
- NPI 1669103347
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891849295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51 SOUTH ROAD",
"address_2": "PO BOX 1747",
"city": "CADIZ",
"state": "KY",
"postal_code": "422111747",
"telephone_number": "270-522-3484",
"fax_number": "270-522-4662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51 SOUTH ROAD",
"city": "CADIZ",
"state": "KY",
"postal_code": "422111747",
"telephone_number": "270-522-3484",
"fax_number": "270-522-4662"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSS",
"first_name": "MICHAEL",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KY",
"license": "KENTUCKY5297",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60052974",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cadiz, KY
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.