Active NPI
Dean Lee Grisham, CRNA
- Certified Registered Nurse Anesthetist
- Fort Riley, KS
National Provider Identifier
1093882763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 557052
- Practice address
- 650 Huebner Rd
Fort Riley, KS 66442-4030 - Phone
- (785) 239-7528
- NPI assigned
- Nov 29, 2006
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 0001197573 | VA | |
| Registered Nurse | 163W00000X | 14117177012 | KS | |
| Certified Registered Nurse Anesthetist | 367500000X | 0024169253 | VA | |
| Certified Registered Nurse Anesthetist | 367500000X | 557052 | KS | Primary |
Addresses
Primary practice location
650 Huebner Rd
Fort Riley, KS 66442-4030
Mailing address
650 Huebner Rd
Fort Riley, KS 66442-4030
Phone (785) 239-7528
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200743350A | Medicaid | KS |
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
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14117177012 | KS | MD | Registered Nurse |
| 0001197573 | VA | MD | Registered Nurse |
| 557052 | KS | MD | Certified Registered Nurse Anesthetist |
| 0024169253 | VA | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anesthesiology Associates of Radford Inc | 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.
-
- Anesthesiology Physician
- Christiansburg, VA
- NPI 1407878465
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678406400000",
"number": "1093882763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 HUEBNER RD",
"city": "FORT RILEY",
"state": "KS",
"postal_code": "664424030",
"telephone_number": "785-239-7528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 HUEBNER RD",
"city": "FORT RILEY",
"state": "KS",
"postal_code": "664424030",
"telephone_number": "785-239-7528"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRISHAM",
"first_name": "DEAN",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-29",
"last_updated": "2023-03-10",
"certification_date": "2023-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "VA",
"license": "0001197573",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "KS",
"license": "14117177012",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "VA",
"license": "0024169253",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "KS",
"license": "557052",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200743350A",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Fort Riley, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.