Active NPI
Grace K. Grajales, FNP
- Family Nurse Practitioner
- East Lyme, CT
National Provider Identifier
1982767786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 4274
- Practice address
- 305 Flanders Rd
East Lyme, CT 06333-1743 - Phone
- (860) 739-0348
- Fax
- (860) 739-6779
- NPI assigned
- Dec 19, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4274 | CT | Primary |
Addresses
Primary practice location
305 Flanders Rd
East Lyme, CT 06333-1743
Mailing address
305 Flanders Rd
East Lyme, CT 06333-1743
Phone (860) 739-0348
Other practice location 1
255 Hempstead St
New London, CT 06320-6204
Phone (860) 443-2896 ext. 1425
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008039710 | Medicaid | CT | |
| 008072609 | Medicaid | CT |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Flanders Pediatrics LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatrics Physician
- East Lyme, CT
- NPI 1861408619
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1982767786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 FLANDERS RD",
"city": "EAST LYME",
"state": "CT",
"postal_code": "063331743",
"telephone_number": "860-739-0348",
"fax_number": "860-739-6779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 FLANDERS RD",
"city": "EAST LYME",
"state": "CT",
"postal_code": "063331743",
"telephone_number": "860-739-0348",
"fax_number": "860-739-6779"
}
],
"practiceLocations": [
{
"address_1": "255 Hempstead St",
"address_purpose": "LOCATION",
"city": "New London",
"state": "CT",
"postal_code": "063206204",
"country_code": "US",
"telephone_number": "860-443-2896 x1425",
"fax_number": "860-442-5909",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GRAJALES",
"first_name": "GRACE",
"middle_name": "K.",
"credential": "FNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-19",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CT",
"license": "4274",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008039710",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008072609",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Lyme, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.