Active NPI
Robert B Grzywacz, DPM
- Podiatrist
- Las Vegas, NV
National Provider Identifier
1316148646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 793965375
- Practice address
- 3221 E Warm Springs Rd
Las Vegas, NV 89120-3157 - Phone
- (702) 733-7617
- Fax
- (702) 733-1732
- NPI assigned
- May 31, 2007
- 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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 793965375 | NV | Primary |
Addresses
Primary practice location
3221 E Warm Springs Rd
Las Vegas, NV 89120-3157
Mailing address
3221 E Warm Springs Rd
Las Vegas, NV 89120-3157
Phone (702) 733-7617
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5623276299 | Other | NV | TIN |
| P00058662 | Other | NV | RAILROAD MEDICARE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 793965375 | NV | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211500800000",
"number": "1316148646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3221 E WARM SPRINGS RD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891203157",
"telephone_number": "702-733-7617",
"fax_number": "702-733-1732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3221 E WARM SPRINGS RD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891203157",
"telephone_number": "702-733-7617",
"fax_number": "702-733-1732"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRZYWACZ",
"first_name": "ROBERT",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-31",
"last_updated": "2008-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "NV",
"license": "793965375",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TIN",
"identifier": "5623276299",
"state": "NV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00058662",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.