Mr Grissim Clark Connery, DO, RD is a medicare enrolled "Internal Medicine" provider in Las Vegas, Nevada. His current practice location is
1707 W Charleston Blvd Ste 100, Las Vegas, Nevada. You can reach out to his office (for appointments etc.) via phone at
(702) 676-3650.
Mr Grissim Clark Connery is licensed to practice in Nevada (license number DO3640) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1427317155.
Healthcare Provider's Profile
| Full Name | Mr Grissim Clark Connery |
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| Gender | Male |
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| Speciality | Internal Medicine |
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| Location | 1707 W Charleston Blvd Ste 100, Las Vegas, Nevada |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1427317155
- Provider Enumeration Date: 05/15/2012
- Last Update Date: 07/10/2024
Medicare PECOS Information:
- PECOS PAC ID: 1254735871
- Enrollment ID: I20240802002959
Medical Identifiers
Medical identifiers for Mr Grissim Clark Connery such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1427317155 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 133V00000X | Dietitian, Registered | 1086129 (Illinois) | Secondary |
| 207R00000X | Internal Medicine | DO3640 (Nevada) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Grissim Clark Connery allows following entities to bill medicare on his behalf.
| Provider Name | Unlv Medicine |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1407397235
PECOS PAC ID: 4183991458
Enrollment ID: O20170517002454 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Grissim Clark Connery is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Mr Grissim Clark Connery, DO, RD
3016 W Charleston Blvd Ste 100,
Las Vegas, NV 89102-1973
Ph: (702) 780-2315 | Mr Grissim Clark Connery, DO, RD
1707 W Charleston Blvd Ste 100,
Las Vegas, NV 89102-2352
Ph: (702) 676-3650 |
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