Grady Reynolds Fort, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G27353 Issued in CA

Practice address

1140 Main St
Livingston Medical Group
Livingston, CA 95334-1257

Phone

(209) 394-7913

NPI assigned

Dec 13, 2006

Last updated

Aug 14, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Enrolled in CA

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.

Enrollment records 1

Specialty

Pediatric Medicine

Education

University of California, San Francisco School of Medicine, 1972

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

McCloud Healthcare Clinic, Inc.Group PAC ID 3779494919, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Medical Center of Mt Shasta Hospital, Mount Shasta, CA, CCN 051319
• Mercy Medical Center Redding Hospital, Redding, CA, CCN 050280
• Fairchild Medical Center Hospital, Yreka, CA, CCN 051316

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: grady.fort.1@25248.direct.athenahealth.com

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.

• McCloud Healthcare Clinic, Inc.

  dba Shasta Cascade Health Centers

  • Federally Qualified Health Center (FQHC)
  • McCloud, CA
  • NPI 1164428488
  Medicare reassignment Care Compare group
• McCloud Healthcare Clinic, Inc.

  dba Shasta Cascade Health Centers- Mt Shasta

  • Federally Qualified Health Center (FQHC)
  • Mount Shasta, CA
  • NPI 1033675582
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Dignity Health

  dba Mercy Medical Center Redding

  • General Acute Care Hospital
  • Redding, CA
  • NPI 1477671535
  Care Compare affiliation
• Dignity Health

  dba Mercy Medical Center Mt. Shasta

  • Critical Access Hospital
  • Mount Shasta, CA
  • NPI 1518085430
  Care Compare affiliation
• Siskiyou Hospital, Inc.

  dba Fairchild Medical Center

  • Critical Access Hospital
  • Yreka, CA
  • NPI 1093892275
  Care Compare affiliation
• Siskiyou Hospital, Inc.

  dba Fairchild Medical Center

  • Critical Access Hospital
  • Yreka, CA
  • NPI 1952701369
  Care Compare affiliation

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1982765582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 W. MINNESOTA AVE",
            "city": "MCCLOUD",
            "state": "CA",
            "postal_code": "96057",
            "telephone_number": "530-964-2389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 MAIN ST",
            "address_2": "LIVINGSTON MEDICAL GROUP",
            "city": "LIVINGSTON",
            "state": "CA",
            "postal_code": "953341257",
            "telephone_number": "209-394-7913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORT",
        "first_name": "GRADY",
        "middle_name": "REYNOLDS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G27353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982765582",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nina Dhanota-Mann
• Melinda Edmondson, APRN
• Samuel D Esparza, M.D.
• Odinaka Eze
• Christina A Ferguson, ATC
• Friends Home Care LLC
• Maria D Garcia Sandoval
• April Garcia
• Stephanie Isabel Garcia, RN
• Garfield Beach CVS LLC (CVS Pharmacy #10360)

• Pediatrics Physician in Livingston, CA
• Providers in Livingston, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 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.