Clinton Lloyd Grimes, BS

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

369026 US Highway 62
Boley, OK 74829

Phone

(918) 667-3367

NPI assigned

Feb 19, 2008

Last updated

Aug 26, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

Practice roles

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

• Jawaun Michael Lewis DO PC

  • Neurology Physician
  • Norman, OK
  • NPI 1356501019
  NPD (past)
• Stepping Stones, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Boley, OK
  • NPI 1649360025
  NPD (past)

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

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566777600000",
    "number": "1073781589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "NBU 6907",
            "city": "PRAGUE",
            "state": "OK",
            "postal_code": "74864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369026 US HIGHWAY 62",
            "city": "BOLEY",
            "state": "OK",
            "postal_code": "74829",
            "telephone_number": "918-667-3367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMES",
        "first_name": "CLINTON",
        "middle_name": "LLOYD",
        "name_prefix": "Mr.",
        "credential": "BS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-19",
        "last_updated": "2019-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100685660D",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100685660A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tanya L Edgell, BA
• Susie Esters
• Carolyn M Farris, RN
• Nola Larue Gibson, RN
• Michelle Leeann Gillham, BA, BHRS, CM
• Rosie Marie Grubbs
• Hayden Scott Harris
• Naeemah Akilah Hasan, RN, BSN, CD
• Darletta Hinds
• Ryan A Holmgren

• Peer Specialist in Boley, OK
• Providers in Boley, OK by specialty
• Peer Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; 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.