MODATHER GRAIN MD
NPI 1619658705
Student in an Organized Health Care Education/Training Program in Rochester, NY

Q: What is Modather Grain's NPI number?

The NPI number for Modather Grain is 1619658705. It was assigned to this individual provider in the NPPES registry on July 31, 2023.

Q: What is Modather Grain's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Modather Grain was last updated on March 24, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months 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.

Active since July 31, 2023PECOS Enrolled

1555 LONG POND RD, ROCHESTER, NY 14626(585) 723-7746(585) 723-7834 Get Directions Write a Review

NPPES record last updated: March 24, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Modather Grain Md NPPES

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

MODATHER GRAIN MD (NPI 1619658705) is an individual student in an organized health care education/training program in Rochester, New York and active in the NPI registry since July 2023. He is enrolled in Medicare PECOS and is a graduate of Other (2015).

NPPES Registry Identity

NPI1619658705

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameMODATHER GRAINCredential: MD

Location Address1555 LONG POND RDRochester, NY 14626-4164

Mailing Address1555 Long Pond RdRochester, NY 14626-4164 · (585) 723-7746 · Fax (585) 723-7834

Phone(585) 723-7746

Fax(585) 723-7834

Sole ProprietorNo

Medical School CMSOtherGraduated 2015

Enumeration DateJuly 31, 2023

Last NPPES UpdateMarch 24, 2026

NPPES CertifiedMarch 24, 2026

✔ NPI 1619658705 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Also ListedHospitalistTaxonomy 208M00000X · License TP901 (KY)

1555 LONG POND RD, Rochester, NY 14626

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Modather Grain Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5395218044

PECOS Enrollment IDI20260624001740

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.

MACKENZIE R. PETTINELLA PA

Physician Assistant (Medical)

1555 LONG POND RD, DEPT. OF MEDICINE
ROCHESTER, NY 14626

Monroe County (585) 723-7870

FAROOQ CHAUDHARY MD

Student in an Organized Health Care Education/Training Program