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GRACE LILLIAN SUPER
NPI 1750082848
Student in an Organized Health Care Education/Training Program in Little Rock, AR

Active since March 15, 2023PECOS Enrolled
4301 W MARKHAM ST # 520, LITTLE ROCK, AR 72205(501) 686-6627 Get Directions Write a Review

NPPES record last updated: April 5, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 5, 2024, Mar 15, 2023 (2 updates tracked since 2023).

About Grace Lillian Super NPPES

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

GRACE LILLIAN SUPER (NPI 1750082848) is an individual student in an organized health care education/training program in Little Rock, Arkansas and active in the NPI registry since March 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1750082848
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameGRACE LILLIAN SUPER
Location Address4301 W MARKHAM ST # 520Little Rock, AR 72205-7101
Mailing Address2619 Centennial BlvdTallahassee, FL 32308-0602 · (850) 645-1232
Phone(501) 686-6627
Sole ProprietorNo
Enumeration DateMarch 15, 2023
Last NPPES UpdateApril 5, 20242 updates tracked since enumeration
NPPES CertifiedApril 5, 2024
✔ NPI 1750082848 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ 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.
4301 W MARKHAM ST # 520, Little Rock, AR 72205
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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)

Grace Lillian Super 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.

SANDRA MINERVA GARCIA OSOGOBIO MD
Colon & Rectal Surgery
4301 W MARKHAM ST # 520
LITTLE ROCK, AR 72205
Pulaski County (501) 686-8000
MISS MARINNA RAEF TADROS MD
Student in an Organized Health Care Education/Training Program
4301 W MARKHAM ST # 520
LITTLE ROCK, AR 72205
Pulaski County (501) 626-6627
MADELINE NACHTIGAL DO
Student in an Organized Health Care Education/Training Program
4301 W MARKHAM ST # 520
LITTLE ROCK, AR 72205
Pulaski County (501) 686-5205
LAUREN JOHNSON
Student in an Organized Health Care Education/Training Program
4301 W MARKHAM ST # 520
LITTLE ROCK, AR 72205
Pulaski County (501) 686-6912
ALEXANDRA GRACE OTWELL MD
Student in an Organized Health Care Education/Training Program
4301 W MARKHAM ST # 520
LITTLE ROCK, AR 72205
Pulaski County (501) 686-6627
DR. LEVI DANIEL WATSON MD
Student in an Organized Health Care Education/Training Program
4301 W MARKHAM ST # 520
LITTLE ROCK, AR 72205
Pulaski County (501) 686-6627
DR. GREGORY TYLER RIVES MD
Surgery
4301 W MARKHAM ST # 520
LITTLE ROCK, AR 72205
Pulaski County (501) 686-8000
JOSEPH DELOACH
Student in an Organized Health Care Education/Training Program
4301 W MARKHAM ST # 520
LITTLE ROCK, AR 72205
Pulaski County (501) 686-6627

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 Grace Super's NPI number?

The NPI number for Grace Super is 1750082848. It was assigned to this individual provider in the NPPES registry on March 15, 2023.

Where is Grace Super located?

Grace Super practices at 4301 W Markham St # 520, Little Rock, AR 72205. The listed phone number is (501) 686-6627.

What is Grace Super's specialty?

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

Is Grace Super enrolled in Medicare?

Yes. Grace Super is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Grace Super was last updated on April 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.