NPIMap

Individual provider Active NPI

Jonathan B Grenoble, M.D.

  • Family Medicine Physician
  • Pittsfield, MA
National Provider Identifier
1205869047
Registry record updated Aug 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
54069 Issued in MA
Practice address
20 Elm St
Pittsfield, MA 01201-6502
Phone
(413) 442-1019
Fax
(413) 447-8521
NPI assigned
Jul 7, 2006
Last updated
Aug 3, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 54069 MA Primary

Addresses

Primary practice location

20 Elm St
Pittsfield, MA 01201-6502

Mailing address

20 Elm St
Pittsfield, MA 01201-6502
Phone (413) 442-1019

Other identifiers 1

IdentifierTypeStateIssuer
3000117MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20040708001364 MA Practitioner - Family Practice 9931187739 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of Ny Upstate Medical University, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Berkshire Family Practice Associates , PCGroup PAC ID 0244561710, 10 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

20 Elm St
Pittsfield, MA 01201-6502
Phone (413) 442-1019

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54069MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Berkshire Family Practice Associates , PC Family Medicine CurrentSince Jul 17, 2019 Accepting new patients
Pittsfield Management Systems Inc. Past Accepting new patients
Berkshire Medical Center Inc. PastSince Jan 1, 2016 Accepting new patients

Locations

20 Elm St
Pittsfield, MA 01201
Phone (413) 442-1019

Interoperability endpoints

  • Direct secure messaging: jonathangrenoble@combfp.medalliesdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mount Greylock Extended Care FacilityPittsfield, MA, CCN 225306 Skilled nursing facility Adp of the SNF Feb 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 8

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280793600000",
    "number": "1205869047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 ELM ST",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012016502",
            "telephone_number": "413-442-1019",
            "fax_number": "413-447-8521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 ELM ST",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012016502",
            "telephone_number": "413-442-1019",
            "fax_number": "413-447-8521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRENOBLE",
        "first_name": "JONATHAN",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2010-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "54069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3000117",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsfield, MA

Sources for this page

Verify at the official NPI Registry.