Active NPI
Alice Dorine Grooms, RN
- Registered Nurse
- Bloomington, IL
National Provider Identifier
1114430360
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 041174697
- Practice address
- 315 Avenue F
Bloomington, IL 61704-7415 - Phone
- (309) 267-9449
- NPI assigned
- Nov 9, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 041174697 | IL | Primary |
Addresses
Primary practice location
315 Avenue F
Bloomington, IL 61704-7415
Mailing address
13001 Taft Rd
Clinton, IL 61727-2646
Phone (217) 853-1804
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)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041174697 | IL | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510185600000",
"number": "1114430360",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13001 TAFT RD",
"city": "CLINTON",
"state": "IL",
"postal_code": "617272646",
"telephone_number": "217-853-1804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 AVENUE F",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617047415",
"telephone_number": "309-267-9449"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROOMS",
"first_name": "ALICE",
"middle_name": "DORINE",
"name_prefix": "Ms.",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-11-09",
"last_updated": "2017-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IL",
"license": "041174697",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
- Mariellen Griffith, ED.D.
- Andrea Lynn Grimes
- Barbara Grissinger
- Megan Ann Grissom-Dubenco, M.S., CCC-SLP
- Brittany Gronset, MT-BC
- Amanda Gruber, DPT
- Gregory V Guard, MD
- Guardian Headache & Pain Management Institute
- Guardian Headache & Pain Management Institute LLC
- Guardian Interventional Pain Management Institute LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.