Individual provider Active NPI

John B Groner, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Kennewick, WA
National Provider Identifier
1184787491
Registry record updated Aug 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
MD00049437 Issued in WA
Practice address
4309 W 27TH PL Ste 202
Kennewick, WA 99338-2908
Phone
(509) 591-4966
Fax
(509) 396-5033
NPI assigned
Dec 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician 2081N0008X MD156621 OR
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X MD156621 OR
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X MD00049437 WA Primary

Addresses

Primary practice location

4309 W 27TH PL Ste 202
Kennewick, WA 99338-2908

Mailing address

4309 W 27TH PL Ste 202
Kennewick, WA 99338-2908
Phone (509) 591-4966

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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

Enrollment IDStateProvider typePAC IDDetails
I20080717000652 WA Practitioner - Physical Medicine and RehabilitationPractitioner - Interventional Pain ManagementPractitioner - Pain Management 5698848083 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and RehabilitationAlso: Interventional Pain Management
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4309 W 27TH PL
Suite 202
Kennewick, WA 99338-2908
Phone (509) 591-4966

Hospital & facility affiliations

  • Kadlec Regional Medical Center Hospital, Richland, WA, CCN 500058
  • Providence St Mary Medical Center Hospital, Walla Walla, WA, CCN 500002

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD156621ORMDNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
MD00049437WAMDPain Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Revitalize Spine & Sports Care PLLC Pain Medicine CurrentSince Jul 1, 2021 Accepting new patients
Prosser Public Hospital District of Benton County Current Accepting new patients
Prosser Public Hospital District of Benton County CurrentSince Mar 1, 2018 Accepting new patients
Prosser Public Hospital District of Benton County CurrentSince Mar 1, 2018 Accepting new patients

Locations

1105 Dale Ave
Benton City, WA 99320
Phone (509) 588-4075

701 Dale Ave
Benton City, WA 99320
Phone (509) 588-4075

4309 W 27th Pl
Ste 202
Kennewick, WA 99338
Phone (509) 591-4966

200 Prosser Health Dr
Prosser, WA 99350
Phone (509) 786-2222

Interoperability endpoints

  • Direct secure messaging: jgroner1110221@wm.providencedirect.org

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628726400000",
    "number": "1184787491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4309 W 27TH PL STE 202",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993382908",
            "telephone_number": "509-591-4966",
            "fax_number": "509-396-5033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 W 27TH PL STE 202",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993382908",
            "telephone_number": "509-591-4966",
            "fax_number": "509-396-5033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRONER",
        "first_name": "JOHN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2021-08-12",
        "certification_date": "2021-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081N0008X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Neuromuscular Medicine",
            "state": "OR",
            "license": "MD156621",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "OR",
            "license": "MD156621",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "WA",
            "license": "MD00049437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennewick, WA

Sources for this page

Verify at the official NPI Registry.