F.G.M.a. ,LLC.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R0028064 Issued in OK

Legal business name

F.G.M.A. ,LLC.

Practice address

5622 N Portland Ave
#102
Oklahoma City, OK 73112-2096

Phone

(405) 917-7590

Fax

(405) 917-7595

NPI assigned

Feb 28, 2007

Last updated

Jun 4, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Susan B Grandle, APRN

Title

Nurse Practitioner

Phone

(405) 917-7590

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Family and Geriatric Medical Associates Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433376000000",
    "number": "1922136480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5622 N PORTLAND AVE",
            "address_2": "#102",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731122096",
            "telephone_number": "405-917-7590",
            "fax_number": "405-917-7595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5622 N PORTLAND AVE",
            "address_2": "#102",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731122096",
            "telephone_number": "405-917-7590",
            "fax_number": "405-917-7595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "F.G.M.A. ,LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2015-06-04",
        "status": "A",
        "authorized_official_last_name": "GRANDLE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "405-917-7590",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R0028064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUSAN GRANDLE LIC #",
            "identifier": "R0028064",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100216830D",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family and Geriatric Medical Associates",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Austin O Ezugha, MED. MHR
• Erin Elaine Ezzell, D.O.
• F C Lawrence II MD PC
• F Charles Goldsmith
• F. Lee Smith, M.D., P.C.
• Abayomi Faboro
• Amanda Factor
• Crystal Nicole Factor, DSW, MSW, LCSW
• Christiana Factory
• Fred Nolan Factory, M.ED

• Family Nurse Practitioner in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.