Kelsey Grimmer, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085004128 Issued in IL

Practice address

900 N Westmoreland Rd
Ste 222
Lake Forest, IL 60045-1674

Phone

(920) 791-1347

NPI assigned

Jul 8, 2008

Last updated

Feb 19, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatologists of Illinois, PLLCGroup PAC ID 9537128004, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kgrimmer@doi.emadirect.md

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.

• Dermatologists of Illinois, PLLC

  dba The Skin Care Center

  • Dermatology Physician
  • Lake Forest, IL
  • NPI 1851358345
  Medicare reassignment Care Compare group
• North Shore Rheumatology

  • Rheumatology Physician
  • Lake Forest, IL
  • NPI 1033176789
  NPD (past)
• Great Lakes Dermatology SC

  dba Ascend Dermatology

  • Dermatology Physician
  • Mount Pleasant, WI
  • NPI 1851467047
  NPD (past)

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

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455840000000",
    "number": "1265695530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N WESTMORELAND RD",
            "address_2": "STE 222",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451674",
            "telephone_number": "920-791-1347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N WESTMORELAND RD",
            "address_2": "STE 222",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451674",
            "telephone_number": "920-791-1347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMMER",
        "first_name": "KELSEY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-08",
        "last_updated": "2016-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "2303",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085004128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ara C Goshgarian, DDS
• Andrew Louis Gostine, MD, MBA
• Mary Josephine Gould, APRN, CNP
• Courtney Grenning
• Charlotte Ann Griffith, MS, RDN
• Michael I Grinberg, R.PH.
• Reilly Grotelueschen, LCSW
• Growing Grounded Therapies PLLC
• Jenna Lauren Gulle
• Deborah Gail Gulson, MD

• Medical Physician Assistant in Lake Forest, IL
• Providers in Lake Forest, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.