NPIMap

Individual provider Active NPI

Timothy Guy Grube, D.O.

  • Obstetrics & Gynecology Physician
  • Frackville, PA
National Provider Identifier
1194720870
Registry record updated Sep 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
OS009280L Issued in PA
Practice address
219 S Balliet St
Frackville, PA 17931-2105
Phone
(570) 874-3404
Fax
(570) 874-1491
NPI assigned
Jun 17, 2005
Last updated
Sep 10, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X OS009280L PA Primary

Addresses

Primary practice location

219 S Balliet St
Frackville, PA 17931-2105

Mailing address

219 S Balliet St
Frackville, PA 17931-2105
Phone (570) 874-3404

Other identifiers 1

IdentifierTypeStateIssuer
0018174270002MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110616000640 PA Practitioner - Obstetrics/Gynecology 9436337649 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Philadelphia College of Osteopathic Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Medical Group P CGroup PAC ID 1355247180, 105 clinicians

Practice addresses (Care Compare)

431 Dowdentown Rd
Pottsville, PA 17901-9111
Phone (570) 399-5235

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS009280LPAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Women's Health Services, P.C. Obstetrics & Gynecology CurrentSince Aug 1, 1996 Accepting new patients
Integrated Medical Group P C CurrentSince Feb 1, 2014 Accepting new patients
Integrated Medical Group, P.C. CurrentSince Feb 1, 2014 Accepting new patients
Lehigh Valley Physician Group Obstetrics & Gynecology Past Accepting new patients

Locations

219 S Balliet St
Frackville, PA 17931
Phone (570) 874-3404

171 Red Horse Rd
Ste 1
Pottsville, PA 17901
Phone (570) 628-2229

420 S Jackson St
Pottsville, PA 17901
Phone (570) 621-5000

431 Dowdentown Rd
Pottsville, PA 17901
Phone (570) 399-5235

48 Tunnel Rd
Ste 104
Pottsville, PA 17901
Phone (570) 622-5555

82 Tunnel Rd
Pottsville, PA 17901
Phone (570) 622-5455

2758 Century Blvd
Ste 1
Wyomissing, PA 19610
Phone (610) 375-0500

Interoperability endpoints

  • Direct secure messaging: tgrube@imgpc.medentdirect.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410307200000",
    "number": "1194720870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 S BALLIET ST",
            "city": "FRACKVILLE",
            "state": "PA",
            "postal_code": "179312105",
            "telephone_number": "570-874-3404",
            "fax_number": "570-874-1491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 S BALLIET ST",
            "city": "FRACKVILLE",
            "state": "PA",
            "postal_code": "179312105",
            "telephone_number": "570-874-3404",
            "fax_number": "570-874-1491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUBE",
        "first_name": "TIMOTHY",
        "middle_name": "GUY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2014-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "PA",
            "license": "OS009280L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018174270002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Frackville, PA

Sources for this page

Verify at the official NPI Registry.