Edward Allan Grimball, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

29702 Issued in KY

Practice address

402 Bogle St
Ste 3
Somerset, KY 42503-2870

Phone

(606) 451-9953

Fax

(606) 451-1533

NPI assigned

Nov 3, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Medical University of South Carolina College of Medicine

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeastern Emergency Physicians LLCGroup PAC ID 2466364997, 776 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lake Cumberland Regional Hospital Hospital, Somerset, KY, CCN 180132
• Knox County Hospital Hospital, Barbourville, KY, CCN 181328

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Merit-based Incentive Payment System (MIPS)

Final score

96.26 of 100Reported as group

Quality

83.59

Improvement activities

40

Cost

90.93

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382
  Medicare reassignment Care Compare group NPD
• Green Valley Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Paducah, KY
  • NPI 1720755739
  Medicare reassignment NPD
• Southern Medical Partners, LLC

  • Emergency Medicine Physician
  • Hazard, KY
  • NPI 1538109962
  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Arh Mary Breckinridge Health Services, Inc.

  • Rural Health Clinic/Center
  • Middlesboro, KY
  • NPI 1962908277

  Hospital

  Care Compare affiliation
• Arh Mary Breckinridge Health Services, Inc.

  • Critical Access Hospital
  • Barbourville, KY
  • NPI 1992176655
  Care Compare affiliation
• Lake Cumberland Regional Hospital LLC

  • Rural Acute Care Hospital
  • Somerset, KY
  • NPI 1619038247
  Care Compare affiliation

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428537600000",
    "number": "1144211541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 BOGLE ST",
            "address_2": "STE 3",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425032870",
            "telephone_number": "606-451-9953",
            "fax_number": "606-451-1533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 BOGLE ST",
            "address_2": "STE 3",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425032870",
            "telephone_number": "606-451-9953",
            "fax_number": "606-451-1533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMBALL",
        "first_name": "EDWARD",
        "middle_name": "ALLAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2015-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "29702",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "29702",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000075035",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN/AETNA",
            "identifier": "5169150",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "37J8",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "1101698818",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHA",
            "identifier": "1181211",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID",
            "identifier": "611350780",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "04-906",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64297021",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordan Gregory
• Rachel Gregory, MS OTR/L
• Jamie Grider, CRNA
• Michael Thomas Griffin, CPSS
• Cody Griggs, LPCC
• Deanna Marie Grubbs, MD
• Angela Nicole Guffey, MS,RDN,LD
• Tammy Ann Guffey, NP
• Rebecca Bianchi Gulock, M.ED., LBA, BCBA
• Guy M. Sava, MD, PSC

• Internal Medicine Physician in Somerset, KY
• Providers in Somerset, KY by specialty
• Internal Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.