Active NPI
Jason W Grimm, ACNP
- Acute Care Nurse Practitioner
- Vandalia, OH
National Provider Identifier
1083866032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- APRN.CNP.025146
- Practice address
- 600 Aviator CT Ste 100B
Vandalia, OH 45377-9474 - Phone
- (210) 860-0626
- NPI assigned
- Oct 21, 2008
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | APRN.CNP.025146 | OH | Primary |
Addresses
Primary practice location
600 Aviator CT Ste 100B
Vandalia, OH 45377-9474
Mailing address
600 Aviator CT Ste 100B
Vandalia, OH 45377-9474
Phone (210) 860-0626
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | jason@statresearch.net |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN.CNP.025146 | OH | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Clinical Research | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601856000000",
"number": "1083866032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 AVIATOR CT STE 100B",
"city": "VANDALIA",
"state": "OH",
"postal_code": "453779474",
"telephone_number": "210-860-0626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 AVIATOR CT STE 100B",
"city": "VANDALIA",
"state": "OH",
"postal_code": "453779474",
"telephone_number": "210-860-0626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMM",
"first_name": "JASON",
"middle_name": "W",
"name_prefix": "Mr.",
"credential": "ACNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-21",
"last_updated": "2020-10-05",
"certification_date": "2020-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "OH",
"license": "APRN.CNP.025146",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "jason@statresearch.net",
"affiliation": "N",
"address_1": "600 Aviator Ct Ste 100B",
"city": "Vandalia",
"state": "OH",
"country_code": "US",
"postal_code": "453779474",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Vandalia, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.