GRACE MEDICAL ASSOCIATION, PA
NPI 1487695631
Internal Medicine in Lewisville, TX
- Organization
- Internal Medicine
- CLIA Number: 45D0986854
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 05-22-2027
About GRACE MEDICAL ASSOCIATION, PA
This page provides the complete NPI Profile along with additional information for Grace Medical Association, Pa, an internist established in Lewisville, Texas operating as a Internal Medicine. The healthcare provider is registered in the NPI registry with number 1487695631 assigned on June 2006. The practitioner's primary taxonomy code is 207R00000X with license number J91000 (TX). The provider is registered as an organization and their NPI record was last updated 12 years ago. Grace Medical Association, Pa operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Dr. Smart O Idemudia M.d., Phd. (Owner)
- NPI
- 1487695631 Verify this NPI
- Provider Name
- GRACE MEDICAL ASSOCIATION, PA
- Entity Type
- Organization
- Location Address
- 200 W. SOUTHWEST PKWY LEWISVILLE, TX 75067
- Location Phone
- (972) 420-6777
- Location Fax
- (972) 420-0656
- Mailing Address
- PO BOX 292128 LEWISVILLE, TX 75029
- Mailing Phone
- (972) 420-6777
- Mailing Fax
- (972) 420-0656
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 06-09-2006
- Last Update Date
- 06-02-2014
- Code Navigator
An internist like Grace Medical Association, Pa is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Internal Medicine
- Taxonomy Code
- 207R00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- J91000
- License State
- TX
- Taxonomy Description
- A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | J91000 (TX) |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 0078DM | OTHER (01) | TX | BLUE CROSS / BLUE SHIELD |
| F46614 | OTHER (01) | TX | COMMERCIAL |
| F46614 | MEDICARE UPIN (02) | TX | |
| 00187J | MEDICARE ID-TYPE UNSPECIFIED (04) | TX | |
| 138993413 | MEDICAID (05) | TX |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 45D0986854
- Facility Type
- Physician Office
- Certificate Effective Date
- May 23, 2025
- Certificate Expiration Date
- May 22, 2027
- Laboratory Director
- SMART O. IDEMUDIA
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Grace Medical Association, Pa to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1487695631, enumerated as an "organization" on June 09, 2006.
The provider is located at 200 W. SOUTHWEST PKWY LEWISVILLE, TX 75067 and the phone number is (972) 420-6777.
Internal Medicine with taxonomy code 207R00000X.
The provider might be accepting Accepts: Blue Cross Blue Shield, Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
