NPIMap

Organization Active NPI

Grin PLLC

  • General Practice Dentistry
  • Idaho Falls, ID
National Provider Identifier
1144720103
Registry record updated Feb 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D3723 Issued in ID
Legal business name
GRIN PLLC
Practice address
2685 Channing Way
Idaho Falls, ID 83404-7518
Phone
(208) 522-1164
NPI assigned
Feb 16, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2018

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

Authorized official

Name
Dr. James G Drake, DMDNPI 1164589982
Title
Doctor/Partner
Phone
(208) 524-0870

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D3723 ID Primary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D3203 ID
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D1989 ID

Addresses

Primary practice location

2685 Channing Way
Idaho Falls, ID 83404-7518

Mailing address

885 Pancheri Dr
Idaho Falls, ID 83402-3344
Phone (208) 524-0870

Other identifiers 4

IdentifierTypeStateIssuer
000886878OtherUNITED CONCORDIA
001493204OtherUNITED CONCORDIA
6K158OtherIDBLUE CROSS OF IDAHO
6C016OtherIDBLUE CROSS OF IDAHO

National Provider Directory

National Provider Directory

Locations

885 Pancheri Dr
Idaho Falls, ID 83402
Phone (208) 524-0870

2685 Channing Way
Idaho Falls, ID 83404
Phone (208) 522-1164

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1518739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518739200000",
    "number": "1144720103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 PANCHERI DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023344",
            "telephone_number": "208-524-0870",
            "fax_number": "208-524-0873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2685 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047518",
            "telephone_number": "208-522-1164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRIN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-16",
        "last_updated": "2018-02-16",
        "status": "A",
        "authorized_official_last_name": "DRAKE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DOCTOR/PARTNER",
        "authorized_official_telephone_number": "208-524-0870",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3723",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3203",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D1989",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "000886878",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "001493204",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "6K158",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "6C016",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.