Mr Grissim Clark Connery, DO, RD is a medicare enrolled "Student In An Organized Health Care Education/training Program" provider in Las Vegas, Nevada. His current practice location is
1701 W Charleston Blvd Ste 230, Las Vegas, Nevada. You can reach out to his office (for appointments etc.) via phone at
(702) 660-8658.
Mr Grissim Clark Connery is licensed to practice in * (Not Available) (license number ) 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 | Student In An Organized Health Care Education/training Program |
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Location | 1701 W Charleston Blvd Ste 230, 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. |
NPI Data:
- NPI Number: 1427317155
- Provider Enumeration Date: 05/15/2012
- Last Update Date: 04/07/2021
Medicare PECOS Information:
- PECOS PAC ID: 1254735871
- Enrollment ID: I20210804001858
Medical Identifiers
Medical identifiers for Mr Grissim Clark Connery such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1427317155 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
133V00000X | Dietitian, Registered | 6827 (Ohio) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
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 |
Mr Grissim Clark Connery, DO, RD 1701 W Charleston Blvd Ste 230, Las Vegas, NV 89102-2312 Ph: (702) 671-2341 | Mr Grissim Clark Connery, DO, RD 1701 W Charleston Blvd Ste 230, Las Vegas, NV 89102-2312 Ph: (702) 660-8658 |
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