GRACE MEDICAL ASSOCIATION, PA
NPI 1487695631
Internal Medicine in Lewisville, TX
About Grace Medical Association, Pa NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GRACE MEDICAL ASSOCIATION, PA (NPI 1487695631) is a healthcare organization registered as an internal medicine in Lewisville, Texas and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through May 22, 2027 and lists Smart O Idemudia, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 5
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Grace Medical Association, Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Grace Medical Association, PA, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 45D0986854
Grace Medical Association · Lewisville, TXFrequently 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 Grace Medical Association, PA's NPI number?
The NPI number for Grace Medical Association, PA is 1487695631. It was assigned to this organization in the NPPES registry on June 9, 2006.
Where is Grace Medical Association, PA located?
Grace Medical Association, PA is located at 200 W. Southwest Pkwy, Lewisville, TX 75067. The listed phone number is (972) 420-6777.
What is Grace Medical Association, PA's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Grace Medical Association, PA enrolled in Medicare?
Yes. Grace Medical Association, PA is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Grace Medical Association, PA?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Grace Medical Association, PA. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Grace Medical Association, PA hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 45D0986854) is associated with this NPI, valid through May 22, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Grace Medical Association, PA was last updated on June 2, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.
# Grace Medical Association, Pa · NPI 1487695631
Internal Medicine organization in Lewisville, Texas. Organization record, active in the CMS NPPES registry since June 9, 2006.
## Identity
- **NPI:** 1487695631 (Entity type: Organization)
- **Enumerated:** June 9, 2006
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Organization subpart:** No
- **Authorized official:** Smart Idemudia, OWNER
## Practice location
- **Address:** 200 W. SOUTHWEST PKWY, Lewisville, TX 75067
- **Phone:** (972) 420-6777 · **Fax:** (972) 420-0656
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Internal Medicine) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 2, 2014
- **Other identifiers:** Other 0078DM (TX); Other F46614 (TX); Medicare UPIN F46614 (TX); and 2 more
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1487695631) · Data from the CMS NPPES public registry.