Georgina Giselle Grimm, FNP
Individual provider Active NPI Family Nurse Practitioner · Oakland, CA
NPI 1104367739 · NPPES record last updated Mar 15, 2017
Key facts
- NPI
- 1104367739
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 95006100 (CA)
- Practice address
- 9925 International Blvd
#5
Oakland, CA 94603-2558 - Phone
- (510) 777-1177
- Fax
- (510) 550-2644
- NPI assigned
- Mar 15, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 12
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Open Door Community Health Centers
Practice addresses (Care Compare)
1150 Foster Ave
Arcata, CA 95521-5986
Phone (707) 826-8610
2200 Tydd St
Eureka, CA 95501-1284
Phone (707) 441-1624
2426 Buhne St
Eureka, CA 95501-3207
Phone (707) 442-4038
3750 Rohnerville Rd
Fortuna, CA 95540-3118
Phone (707) 725-6101
38883 Hwy 299
Willow Creek, CA 95573-0726
Phone (530) 629-3111
785 18TH St
Arcata, CA 95521-5683
Phone (707) 822-2481
Hospital & facility affiliations
- Providence at Home With Compassus Home Health, Humboldt
- Providence St Joseph Hospital
- Providence Redwood Memorial Hospital
- Mad River Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170727001553 | CA | Practitioner - Nurse Practitioner | 5799055596 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95006100 | CA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Open Door Community Health Centers | Current | Accepting new patients | |
| Open Door Community Health Centers | Current | Accepting new patients | |
| Open Door Community Health Centers | Current | Accepting new patients | |
| Open Door Community Health Centers | Current |
Accepting new patients | |
| Open Door Community Health Centers | Current | Accepting new patients | |
| Open Door Community Health Centers | Current |
Accepting new patients |
Locations
785 18th St
Arcata, CA 95521
Phone (707) 822-2481
770 10th St
Arcata, CA 95521
Phone (707) 826-8610
1275 8th St
Arcata, CA 95521
550 E Washington Blvd
Crescent City, CA 95531
Phone (707) 465-4636
2200 Tydd St
Eureka, CA 95501
Phone (707) 269-7051
3306 Renner Dr
Fortuna, CA 95540
Phone (707) 725-6101
1644 Central Ave
McKinleyville, CA 95519
Phone (707) 839-3068
Interoperability endpoints
- ggrimm251301@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 95006100 | CA | Yes |
Addresses
Primary practice location
9925 International Blvd
#5
Oakland, CA 94603-2558
Mailing address
5018 Shafter Ave
Oakland, CA 94609-2221
Phone (510) 388-3261
Other providers in Oakland, CA
- Edward Joseph Grigas
- Jonathan Gilbert Griggs
- Cassandra Grima
- Andrew Grimes
- Marylynn Grimes
- Christopher D. Grimsrud
- Scott Grinthal
- Lisa Grismer
- Rain L Griswold
- Rozalyna Dungo Gritten
All providers in Oakland, CA · Family Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 15, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.