Individual provider Active NPI

Serena Dawn Woods-Grimm, M.D.

  • Family Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1003009705
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
37116 Issued in AZ
Practice address
201 N Central Ave
Phoenix, AZ 85004-8001
Phone
(602) 221-6326
NPI assigned
Aug 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 37116 AZ Primary

Addresses

Primary practice location

201 N Central Ave
Phoenix, AZ 85004-8001

Mailing address

7113 W Superior Ave
Phoenix, AZ 85043-7293
Phone (623) 210-1150

Other practice location 1

2927 N 7th Ave
Phoenix, AZ 85013-4102
Phone (602) 406-3153

Other identifiers 1

IdentifierTypeStateIssuer
325855MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
37116AZMDFamily Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1003009705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7113 W SUPERIOR AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850437293",
            "telephone_number": "623-210-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N CENTRAL AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850048001",
            "telephone_number": "602-221-6326"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2927 N 7th Ave",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850134102",
            "country_code": "US",
            "telephone_number": "602-406-3153",
            "fax_number": "602-406-7176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOODS-GRIMM",
        "first_name": "SERENA",
        "middle_name": "DAWN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-26",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "37116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "325855",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.