Active NPI
M Jill Gronholz-Dero
- Family Medicine Physician
- Coeur D Alene, ID
National Provider Identifier
1093700593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0-45
- Practice address
- 914 W Ironwood Dr
Coeur D Alene, ID 83814-4927 - Phone
- (208) 765-5922
- Fax
- (208) 664-3169
- NPI assigned
- Sep 12, 2005
- 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 | 0-45 | ID | Primary |
Addresses
Primary practice location
914 W Ironwood Dr
Coeur D Alene, ID 83814-4927
Mailing address
914 W Ironwood Dr
Coeur D Alene, ID 83814-4927
Phone (208) 765-5922
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 Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0-45 | ID | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093700593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "914 W IRONWOOD DR",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838144927",
"telephone_number": "208-765-5922",
"fax_number": "208-664-3169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "914 W IRONWOOD DR",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838144927",
"telephone_number": "208-765-5922",
"fax_number": "208-664-3169"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRONHOLZ-DERO",
"first_name": "M",
"middle_name": "JILL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "0-45",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coeur D Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.