Active NPI
Sean C. Grinovich, M.D.
- Ophthalmology Physician
- Round Rock, TX
National Provider Identifier
1174583439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- K0310
- Practice address
- 300 University Blvd
Round Rock, TX 78665-1032 - Phone
- (512) 509-2020
- NPI assigned
- Mar 23, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | K0310 | TX | Primary |
Addresses
Primary practice location
300 University Blvd
Round Rock, TX 78665-1032
Mailing address
PO Box 847408
Dallas, TX 75284-7408
Phone (254) 724-2111
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 82706N | Other | TX | BLUE SHIELD |
| 1029589-01 | Other | TX | CSHCN |
| 1029589-02 | Medicaid | TX | |
| 180040587 | Other | TX | RR/MEDICARE |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184284800000",
"number": "1174583439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 847408",
"city": "DALLAS",
"state": "TX",
"postal_code": "752847408",
"telephone_number": "254-724-2111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 UNIVERSITY BLVD",
"city": "ROUND ROCK",
"state": "TX",
"postal_code": "786651032",
"telephone_number": "512-509-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRINOVICH",
"first_name": "SEAN",
"middle_name": "C.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-23",
"last_updated": "2007-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "TX",
"license": "K0310",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "82706N",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CSHCN",
"identifier": "1029589-01",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1029589-02",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR/MEDICARE",
"identifier": "180040587",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Round Rock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.