John R Grolich, BA

Primary specialty

Basic Emergency Medical TechnicianTaxonomy code 146N00000X

Practice address

2855 Miller Dr Ste 117
Plymouth, IN 46563-8091

Phone

(574) 936-7777

Fax

(574) 341-1072

NPI assigned

Nov 14, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

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

{
    "created_epoch": "1573689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573689600000",
    "number": "1093350902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 MILLER DR STE 117",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465638091",
            "telephone_number": "574-936-7777",
            "fax_number": "574-341-1072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 MILLER DR STE 117",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465638091",
            "telephone_number": "574-936-7777",
            "fax_number": "574-341-1072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROLICH",
        "first_name": "JOHN",
        "middle_name": "R",
        "credential": "BA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-14",
        "last_updated": "2019-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kclauss@lifeplexmedical.com",
            "affiliation": "N",
            "address_1": "2855 Miller Dr Ste 117",
            "city": "Plymouth",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465638091",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 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.