McKenna Graham, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601011988 Issued in MI

Practice address

1790 30TH St
Boulder, CO 80301-1022

Phone

(303) 997-1733

NPI assigned

Apr 23, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dynamic Athlete PLLCGroup PAC ID 7113384033, 2 clinicians

Practice addresses (Care Compare)

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.

• Dynamic Athlete PLLC

  • Sports Medicine (Internal Medicine) Physician
  • Boulder, CO
  • NPI 1841986494
  Medicare reassignment Care Compare group
• Arvada Eye Associates LLP

  • Ophthalmology Physician
  • Arvada, CO
  • NPI 1023816113
  NPD

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

{
    "created_epoch": "1713830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1982459707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4965 GROVER DR",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481169755",
            "telephone_number": "810-599-6281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 30TH ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011022",
            "telephone_number": "303-997-1733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "MCKENNA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-23",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Marie Graffeo Gardner, DDS
• Andrew Graham
• Brad Graham, M.ED., LPC
• Connor W Graham, M.D.
• Joanne Gesualdi Graham
• Trevor Graham, PSY.D.
• Vicky Graham, O.D.
• Vivienne Gramza
• Johanna Granger, LAC
• Dayna Granston, RN, RXN, CNS, APRN

• Physician Assistant in Boulder, CO
• Providers in Boulder, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; 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.