Active NPI
Kimberly Patricia Grill, PA
- Physician Assistant
- Worcester, MA
National Provider Identifier
1164032629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA8055
- Practice address
- 5 Neponset St
Worcester, MA 01606-2714 - Phone
- (508) 595-2300
- Fax
- (508) 535-1523
- NPI assigned
- Aug 8, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA8055 | MA | Primary |
Addresses
Primary practice location
5 Neponset St
Worcester, MA 01606-2714
Mailing address
5 Neponset St
Worcester, MA 01606-2714
Phone (508) 595-2300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110171499A | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
5 Neponset St
Worcesteer, MA 01606-2714
Phone (508) 595-2300
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Interoperability endpoints
- kimberly.isleib.npi1164032629.reliant@direct.optumcare.masshiway.net
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.
-
- Family Medicine Physician
- Worcester, MA
- NPI 1720017528
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701302400000",
"number": "1164032629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 NEPONSET ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016062714",
"telephone_number": "508-595-2300",
"fax_number": "508-535-1523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 NEPONSET ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016062714",
"telephone_number": "508-595-2300",
"fax_number": "508-535-1523"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRILL",
"first_name": "KIMBERLY",
"middle_name": "PATRICIA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-08",
"last_updated": "2023-11-30",
"certification_date": "2023-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MA",
"license": "PA8055",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110171499A",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; 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.