NPIMap

Organization Active NPI

Pamella S Gronemeyer

  • Clinical Medical Laboratory
  • Highland, IL
National Provider Identifier
1194874966
Registry record updated Nov 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
207ZP0105X Issued in IL
Legal business name
PAMELLA S GRONEMEYER
Practice address
1270 Mercantile Dr
Highland, IL 62249
Phone
(618) 651-8097
Fax
(618) 651-8097
NPI assigned
Jan 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2013

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

Authorized official

Name
Dr. Pamella Suzzanne Gronemeyer, MDNPI 1942285010
Title
Sole Propietor
Phone
(618) 651-8097

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pathology/Laboratory Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0105X
Clinical Medical Laboratory 291U00000X 207ZP0105X IL Primary

Addresses

Primary practice location

1270 Mercantile Dr
Highland, IL 62249

Mailing address

1280 Mercantile Dr
Highland, IL 62249-1256
Phone (618) 654-8985

Other identifiers 7

IdentifierTypeStateIssuer
575343394MedicaidIL
036062202MedicaidIL
036043088MedicaidIL
CK0761OtherILRR MEDICARE PIN
036050692MedicaidIL
036054213MedicaidIL
036057055MedicaidIL

Other names 1

  • SEMC Pathology Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0982965Semc Pathology LLC1270 Mercantile Drive, Highland, IL 62249AccreditationJan 24, 2028

National Provider Directory

National Provider Directory

Locations

1515 Main St
Highland, IL 62249
Phone (618) 651-2600

1280 Mercantile Dr
Highland, IL 62249

325 Spring St
Redbud, IL 62278
Phone (618) 282-5165

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385078400000",
    "number": "1194874966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1280 MERCANTILE DR",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622491256",
            "telephone_number": "618-654-8985",
            "fax_number": "618-651-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1270 MERCANTILE DR",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "62249",
            "telephone_number": "618-651-8097",
            "fax_number": "618-651-8097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAMELLA S GRONEMEYER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2013-11-22",
        "status": "A",
        "authorized_official_last_name": "GRONEMEYER",
        "authorized_official_first_name": "PAMELLA",
        "authorized_official_middle_name": "SUZZANNE",
        "authorized_official_title_or_position": "SOLE PROPIETOR",
        "authorized_official_telephone_number": "618-651-8097",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0105X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IL",
            "license": "207ZP0105X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "575343394",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036062202",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036043088",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "CK0761",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036050692",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036054213",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036057055",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SEMC Pathology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Highland, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.

Verify at the official NPI Registry.