DR. DANIEL GRISSOM M.D.
NPI 1063943686
Pediatrics - Pediatric Emergency Medicine in Las Vegas, NV

Q: What is Daniel Grissom's NPI number?

The NPI number for Daniel Grissom is 1063943686. It was assigned to this individual provider in the NPPES registry on March 24, 2017.

Q: What is Daniel Grissom's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Emergency Medicine, with taxonomy code 2080P0204X.

Q: When was this NPI record last updated?

The NPPES record for Daniel Grissom was last updated on October 29, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since March 24, 2017PECOS Enrolled

1800 W CHARLESTON BLVD, LAS VEGAS, NV 89102(702) 383-1958 Get Directions Write a Review

NPPES record last updated: October 29, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 10, 2024, Mar 27, 2023, Aug 26, 2022 and 2 more (5 updates tracked since 2017).

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About Dr. Daniel Grissom M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DANIEL GRISSOM M.D. (NPI 1063943686) is an individual pediatric emergency medicine provider in Las Vegas, Nevada, licensed in Nevada (24016) and active in the NPI registry since March 2017. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063943686

Entity TypeIndividualMale

Primary Taxonomy2080P0204X

Provider Legal NameDR. DANIEL GRISSOMCredential: M.D.

Location Address1800 W CHARLESTON BLVDLas Vegas, NV 89102-2386

Mailing Address1800 W Charleston BlvdLas Vegas, NV 89102-2386 · (702) 383-2000

Phone(702) 383-1958

Sole ProprietorNo

Enumeration DateMarch 24, 2017

Last NPPES UpdateOctober 29, 20245 updates tracked since enumeration

NPPES CertifiedOctober 29, 2024

✔ NPI 1063943686 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Pediatric Emergency MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080P0204X

License✔ Licensed in NV · 24016

Definition

A pediatrician who has special qualifications to manage emergencies in infants and children.

Also ListedPediatricsTaxonomy 208000000X · License 01084383A (IN)

1800 W CHARLESTON BLVD, Las Vegas, NV 89102

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Daniel Grissom M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHAEL M LEE MD

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