Active NPI
Michael Thomas Grant, M D
- Specialist
- West Seneca, NY
National Provider Identifier
1982694717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 147528
- Practice address
- 550 Orchard Park Rd
Building B, Suite 105
West Seneca, NY 14224-2646 - Phone
- (716) 677-6404
- Fax
- (716) 677-6407
- NPI assigned
- Oct 24, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 147528 | NY | Primary |
Addresses
Primary practice location
550 Orchard Park Rd
Building B, Suite 105
West Seneca, NY 14224-2646
Mailing address
550 Orchard Park Rd
Building B, Suite 105
West Seneca, NY 14224-2646
Phone (716) 677-6404
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00886879 | Medicaid | NY | |
| BB1860 | Other | NY | MEDICARE |
| 00010067501 | Other | NY | UNIVERA |
| 0902816 | Other | NY | INDEPENDENT HEALTH |
| AA0091 | Other | MEDICARE LEGACY # | |
| 000500843001 | Other | NY | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 147528 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327276800000",
"number": "1982694717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 ORCHARD PARK RD",
"address_2": "BUILDING B, SUITE 105",
"city": "WEST SENECA",
"state": "NY",
"postal_code": "142242646",
"telephone_number": "716-677-6404",
"fax_number": "716-677-6407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 ORCHARD PARK RD",
"address_2": "BUILDING B, SUITE 105",
"city": "WEST SENECA",
"state": "NY",
"postal_code": "142242646",
"telephone_number": "716-677-6404",
"fax_number": "716-677-6407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "MICHAEL",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "M D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-24",
"last_updated": "2012-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "147528",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00886879",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "BB1860",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNIVERA",
"identifier": "00010067501",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENT HEALTH",
"identifier": "0902816",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE LEGACY #",
"identifier": "AA0091",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "000500843001",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Seneca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.