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GRADIE B MIXON JR. MD
NPI 1164455267
Anesthesiology in Modesto, CA

Active since July 09, 2006PECOS EnrolledAccepts Medicare Assignment
4601 DALE ROAD, MODESTO, CA 95356(209) 735-5000 Get Directions Write a Review

NPPES record last updated: February 11, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Gradie B Mixon Jr. Md NPPES

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

GRADIE B MIXON JR. MD (NPI 1164455267) is an individual anesthesiology provider in Modesto, California, licensed in California (G57069) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS and is a graduate of Loma Linda University School Of Medicine (1980).

NPPES Registry Identity

NPI1164455267
Entity TypeIndividualMale
Primary Taxonomy207L00000X
Provider Legal NameGRADIE B MIXON JR.Credential: MD
Location Address4601 DALE ROADModesto, CA 95356
Mailing Address604 Cherry Hill CtModesto, CA 95356-9556 · (209) 522-9566
Phone(209) 735-5000
Sole ProprietorYes
Medical School CMSLoma Linda University School Of MedicineGraduated 1980
Enumeration DateJuly 9, 2006
Last NPPES UpdateFebruary 11, 2022
✔ NPI 1164455267 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAnesthesiologyAllopathic & Osteopathic Physicians
Taxonomy Code207L00000X
License✔ Licensed in CA · G57069
Definition
An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation or an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery. In addition to these management responsibilities, the anesthesiologist provides medical management and consultation in pain management and critical care medicine. Anesthesiologists diagnose and treat acute, long-standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post-anesthesia recovery.
4601 DALE ROAD, Modesto, CA 95356
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Gradie B Mixon Jr. Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3577603174
PECOS Enrollment IDI20091211000485
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.

Medicare Billing Reassignment

Medicare enrollment records show Gradie Mixon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Permanente Medical Group Inc
25 mi
Internal Medicine
7373 WEST LANE
Stockton, CA 95210
  • Reassigned Medicare billing, California enrollment
  • 20,078 clinicians in this Medicare group
NPI 1548343510 (209) 476-2000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 4

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

ALEXANDER KA JUN YU DO
Emergency Medicine
4601 DALE ROAD
MODESTO, CA 95356
Stanislaus County (209) 735-5000
MISS ADRIANNE EISABEL PAYAN MS, CCC-SLP
Speech-Language Pathologist
4601 DALE ROAD
MODESTO, CA 95356
Stanislaus County (209) 735-7040
GRACE RUYIN CHEN PHARM.D
Pharmacist
4601 DALE ROAD
MODESTO, CA 95356
Stanislaus County (209) 735-3973
DR. ALFRED CHARLES GAYMON M.D.
Internal Medicine (Gastroenterology)
4601 DALE ROAD
MODESTO, CA 95356
Stanislaus County (973) 699-2160

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gradie Mixon's NPI number?

The NPI number for Gradie Mixon is 1164455267. It was assigned to this individual provider in the NPPES registry on July 9, 2006.

Where is Gradie Mixon located?

Gradie Mixon practices at 4601 Dale Road, Modesto, CA 95356. The listed phone number is (209) 735-5000.

What is Gradie Mixon's specialty?

The primary specialty registered for this NPI is Anesthesiology with taxonomy code 207L00000X.

Is Gradie Mixon enrolled in Medicare?

Yes. Gradie Mixon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Gradie Mixon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Gradie Mixon reassigns Medicare benefits to Permanente Medical Group Inc (Stockton, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Gradie Mixon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Gradie Mixon was last updated on February 11, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.