NATHAN LEE GRANNEMAN (M.D.) – Emergency Medicine Physician, NPI 1689960171
Emergency Medicine Physician
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
144 SPORTS MEDICINE in MO
Provider Addresses for NATHAN LEE GRANNEMAN (M.D.)
18019 THORNBROOK CT
BOONVILLE, MO 652332161
Phone: (660) 265-6441
Type: Mailing
200 CORPORATE LAKE DR
COLUMBIA, MO 652037172
Phone: (573) 814-1170
Type: Location
401 N KEENE ST
COLUMBIA, MO 652016625
Phone: (573) 876-1600
Fax: (573) 876-1606
Type: Mailing
601 W Business Loop 70 Ste 275
Columbia, MO 652032522
Phone: (573) 874-0008
Fax: (573) 875-5350
Type: Location
PO BOX 843966
KANSAS CITY, MO 641843966
Phone: (573) 884-3300
Fax: (573) 884-0943
Type: Mailing
3916 S PROVIDENCE RD STE 101
COLUMBIA, MO 652037152
Phone: (573) 882-1662
Fax: (573) 882-6228
Type: Location
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: 2014-03-06
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20140306000407 | I | Emergency Medicine | MO | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 65233)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | MO | |
| Nurse Practitioner | MO | |
| Nurse Practitioner | MO | |
| Hospitalist, Internal Medicine | MO | |
| Nurse Practitioner | MO | |
| Physical Therapist In Private Practice | MO | |
| - | WI | |
| Infectious Disease, Hospitalist, Internal Medicine | NM | |
| Internal Medicine, Hospitalist | MO | |
| - | MO |
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