Dynesha Dione Mason-Grissom, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

2500 Galen Dr Ste 104
Champaign, IL 61821-7038

Phone

(217) 693-6072

NPI assigned

Nov 13, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.dyneshamason-grissom@146897.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ymg Psychological Services, PLLC

  • Clinical Psychologist
  • Champaign, IL
  • NPI 1629787239
  NPD Authorized official
• Edgewood Clinical Services, P.C.

  • Psychologist
  • Naperville, IL
  • NPI 1295914646
  NPD (past)

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

{
    "created_epoch": "1542067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579564800000",
    "number": "1043789688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 GALEN DR STE 104",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618217038",
            "telephone_number": "217-693-6072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 GALEN DR STE 104",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618217038",
            "telephone_number": "217-693-6072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASON-GRISSOM",
        "first_name": "DYNESHA",
        "middle_name": "DIONE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-13",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "dgrissom@psychologyspecialist.com",
            "affiliation": "N",
            "endpointDescription": "Work Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2500 Galen Dr Ste 104",
            "city": "Champaign",
            "state": "IL",
            "country_code": "US",
            "postal_code": "618217038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Matthew Adam Martinez
• Suzanne Martinez, LMFT
• Eva G Martone, MSW
• Susan Masareth
• Ellie Masengale, LSW
• Deetra Michelle Mason
• Katelyn Mason
• Rachel Mateyka
• Wendy Mathewson, LPC
• Rachel McCullough Matthews, D.MIN., LPC, LCPC

• Psychologist in Champaign, IL
• Providers in Champaign, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.