Active NPI
Ellen H. Gryniewicz, MD
- Family Medicine Physician
- Ypsilanti, MI
National Provider Identifier
1073536181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301032462
- Practice address
- 3145 W Clark Rd
Suite 401
Ypsilanti, MI 48197-1120 - Phone
- (734) 528-5700
- Fax
- (734) 528-5701
- NPI assigned
- Jul 26, 2006
- Last updated
- Feb 11, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301032462 | MI | Primary |
Addresses
Primary practice location
3145 W Clark Rd
Suite 401
Ypsilanti, MI 48197-1120
Mailing address
3145 W Clark Rd
Suite 401
Ypsilanti, MI 48197-1120
Phone (734) 528-5700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4681485-10 | Medicaid | MI |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 4301032462 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392076800000",
"number": "1073536181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3145 W CLARK RD",
"address_2": "SUITE 401",
"city": "YPSILANTI",
"state": "MI",
"postal_code": "481971120",
"telephone_number": "734-528-5700",
"fax_number": "734-528-5701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3145 W CLARK RD",
"address_2": "SUITE 401",
"city": "YPSILANTI",
"state": "MI",
"postal_code": "481971120",
"telephone_number": "734-528-5700",
"fax_number": "734-528-5701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRYNIEWICZ",
"first_name": "ELLEN",
"middle_name": "H.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-26",
"last_updated": "2014-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301032462",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4681485-10",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ypsilanti, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.