MR. NICHOLAS J JR. GRANDE (PAC) – Medical Physician Assistant, NPI 1316085756
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,648 PHYSICIAN ASSISTANT in IA
Provider Addresses for MR. NICHOLAS J JR. GRANDE (PAC)
650 HUEBNER RD
FORT RILEY, KS 664424030
Phone:
Type: Mailing
1227 E RUSHOLME ST
DAVENPORT, IA 528032459
Phone: (563) 421-1000
Type: Location
Bassett Army Community Hospital, 4076, Neely Road, South Fairbanks, Fairbanks, Fairbanks North Star Borough, Alaska, 99703, United States
BASSETT ARMY COMMUNITY HOSPITAL
FORT WAINWRIGHT, AK 99709
Phone: (907) 361-4000
Fax: (907) 361-4835
Type: Location
2555, Twin Lakes Drive, Broadmoor, Fairbanks North Star Borough, Alaska, 99709, United States
FAIRBANKS, AK 997092597
Phone: (570) 406-3540
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-10-20
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20221206000356 | I | Physician Assistant | IA | TBD |
| I20240410001606 | I | Physician Assistant | IL | TBD |
| I20251020001915 | I | Physician Assistant | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 23 | 23 | $0 |
Insurance plans in this area (ZIP 66442)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | CA | |
| Physician Assistant | CA | |
| - | CA | |
| Nurse Practitioner | GA | |
| Nurse Practitioner | FL | |
| - | CA | |
| - | CA | |
| Nurse Practitioner | CA | |
| Physician Assistant | CA | |
| Physician Assistant | CA |
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