BRENT THOMAS GRACEFFA (NPI# 1306255641) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306255641 |
| Entity Type | Individual |
| Full Name | BRENT THOMAS GRACEFFA |
| Credential | IDC |
| Practice Address |
107 Strawbridge Dr Rockton IL 61072-2957 |
| Practice Telephone | 7602121995 |
| Mailing Telephone | 7602121995 |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2014-08-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| Street Address |
107 STRAWBRIDGE DR |
| City | ROCKTON |
| State | IL |
| Zip Code | 61072-2957 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750822649 | Brianna Helene Jensen | Specialist/Technologist | 11746 Deacon Dr, Rockton, IL 61072 | 2017-03-13 |
| 1891085767 | James Adrian Fogarty | Psychologist | 122 S. Prairie St. Suite A, Rockton, IL 61072 | 2011-04-13 |
| 1871623447 | Wal-mart Stores, Inc Dba Wal-mart | Technician/Technologist | 4781 E. Rockton Rd., Rockton, IL 61072 | 2007-03-06 |
| 1215070487 | Shelly L Patchett | Social Worker | 1107 N Blackhawk Blvd, Suite 8, Rockton, IL 61072-1500 | 2007-02-15 |
| 1245301472 | Brandi M Lander | Counselor | 1107 N. Blackhawk Blvd, Suite 8, Rockton, IL 61072-1500 | 2006-11-10 |
| 1033551320 | Stateline Counseling Services LLC | Social Worker | 1107 N Blackhawk Blvd, Suite 8, Rockton, IL 61072-1500 | 2013-07-26 |
| 1811987886 | Vasil Nika | Family Medicine | 1511 N Blackhawk Blvd, University Primary Care Clinic @ Rockton, Rockton, IL 61072-1513 | 2005-10-21 |
| 1245747971 | Nicole Atanasoff | Nurse Practitioner | 1511 N Blackhawk Blvd, Rockton, IL 61072-1513 | 2018-01-03 |
| 1588964712 | Carole J Eatock | Nurse Practitioner | 1511 N Blackhawk Blvd, Rockton, IL 61072-1513 | 2010-10-21 |
| 1952348831 | Board of Trustees of The University of Illinois | Family Medicine | 1511 N Blackhawk Blvd, Rockton, IL 61072-1513 | 2006-06-01 |
| Find all providers in zip 61072 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013315068 | Rene Garcia Cantu Jr. | Military Health Care Provider | Captain James A. Lovell Federal Health Care Center, 3001 Green Bay Road, North Chicago, IL 60064 | 2014-12-08 |
| 1215333299 | Jonathan Ramonbeebe | Military Health Care Provider | 3694 Minnesota Ave Apt D, Great Lakes, IL 60088-1714 | 2014-11-18 |
| 1316340615 | Kevin Thomas | Military Health Care Provider | 1126 Furlong Dr, Libertyville, IL 60048-3701 | 2014-09-30 |
| 1194148304 | Steven Flannagan | Military Health Care Provider | 420 Heatherwood Dr, Oswego, IL 60543-7587 | 2014-01-23 |
| 1093158792 | Erik Lee Myers | Military Health Care Provider | Capt James A Lovell Fhcc, North Chicago, IL 60088-8980 | 2013-04-11 |
| 1164736302 | Clinton Lariscy | Military Health Care Provider | 3355 Illinois St, Recruit Training Command Great Lakes, Great Lakes, IL 60088 | 2010-07-29 |
| 1497917876 | Scott David Arnold | Military Health Care Provider | 320 Dewey Ave Ste A, Naval Special Warfare Preparatory School Bldg 322, Great Lakes, IL 60088-2911 | 2008-06-27 |
| 1184883688 | Michael Paul Coffman | Military Health Care Provider | 601 D Street, Great Lakes, IL 60088-2822 | 2008-06-09 |
| 1265691554 | Michael Ivan Arnold | Military Health Care Provider | 328 W Biros Ln, Round Lake, IL 60073-5607 | 2008-06-03 |
| 1184809048 | Rodolfo Pineda Manansala | Military Health Care Provider | 601 D St Bldg 130-h, Great Lakes, IL 60088-2822 | 2008-01-09 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on BRENT THOMAS GRACEFFA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.