Michael Jack Grossman, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G33405 Issued in CA

Practice address

24432 Muirlands Blvd
Suite 111
Lake Forest, CA 92630-3939

Phone

(949) 770-7301

Fax

(949) 770-0634

NPI assigned

Jan 1, 2007

Last updated

Mar 27, 2008By 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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 7, 2025 through Apr 7, 2027

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.

• Grossman Medical Rejuvenation Inc

  • Family Medicine Physician
  • Newport Beach, CA
  • NPI 1063260248
  NPD Authorized official
• Michael Jack Grossman, M.D., Inc

  dba BodyLogicMD of Irvine

  • Family Medicine Physician
  • Newport Beach, CA
  • NPI 1952543316
  NPD (past) Authorized official
• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  NPD (past)

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

{
    "created_epoch": "1167609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206576000000",
    "number": "1942367008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24432 MUIRLANDS BLVD",
            "address_2": "SUITE 111",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926303939",
            "telephone_number": "949-770-7501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24432 MUIRLANDS BLVD",
            "address_2": "SUITE 111",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926303939",
            "telephone_number": "949-770-7301",
            "fax_number": "949-770-0634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSSMAN",
        "first_name": "MICHAEL",
        "middle_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-01",
        "last_updated": "2008-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G33405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "G33405",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hanna Noel Green
• Nathanael Gideon Green
• Janiyah Greene
• William Young Gregg, DDS
• Heather Grifftih, BCBA
• Victoria Gudino
• Ryan Guerra, DPT
• Christine Marie Guevara, MOTR
• Charick Guillen
• Heba Guirguis, DDS

• Family Medicine Physician in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.