Active NPI
Jason Michael Grinter, DDS
- Dentist
- Rockford, IL
National Provider Identifier
1255401899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Practice address
- 275 N Phelps Ave
Rockford, IL 61108-2434 - Phone
- (815) 484-8678
- NPI assigned
- Nov 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | IL | Primary |
Addresses
Primary practice location
275 N Phelps Ave
Rockford, IL 61108-2434
Mailing address
4316 N Clarendon Ave
#1611
Chicago, IL 60613-1562
Phone (773) 369-5428
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019026609 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Milestone, Inc. | Dentist | Past | Accepting new patients |
| Milestone Dental Clinic | Past | Accepting new patients | |
| Park City Dental, PC | Dentist | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Dentist
- Rockford, IL
- NPI 1225469596
-
- General Practice Dentistry
- Rockford, IL
- NPI 1841461845
-
- Dentist
- Rockford, IL
- NPI 1689848798
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1255401899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4316 N CLARENDON AVE",
"address_2": "#1611",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606131562",
"telephone_number": "773-369-5428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 N PHELPS AVE",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611082434",
"telephone_number": "815-484-8678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRINTER",
"first_name": "JASON",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-09",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.