Individual provider Active NPI

David Richard Grill, MD

  • Internal Medicine Physician
  • Freeport, NY
National Provider Identifier
1316936826
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
149125 Issued in NY
Practice address
121 S Ocean Ave
Freeport, NY 11520-4452
Phone
(516) 379-5005
Fax
(516) 379-9053
NPI assigned
Oct 18, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 149125 NY Primary

Addresses

Primary practice location

121 S Ocean Ave
Freeport, NY 11520-4452

Mailing address

121 S Ocean Ave
Freeport, NY 11520-4452
Phone (516) 379-5005

Other identifiers 1

IdentifierTypeStateIssuer
00842966MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110922000470 NY Practitioner - Internal Medicine 5991976946 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

121 S Ocean Ave
Suite 1
Freeport, NY 11520-4558
Phone (516) 379-5005

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
149125NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Howard Grill MD and David Grill MD CurrentSince Jul 1, 1984 Accepting new patients

Locations

121 S Ocean Ave
Ste 1
Freeport, NY 11520
Phone (516) 379-5005

Organizations & group practices 1

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 4

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": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316936826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 S OCEAN AVE",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "115204452",
            "telephone_number": "516-379-5005",
            "fax_number": "516-379-9053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 S OCEAN AVE",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "115204452",
            "telephone_number": "516-379-5005",
            "fax_number": "516-379-9053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRILL",
        "first_name": "DAVID",
        "middle_name": "RICHARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "149125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00842966",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Freeport, NY

Sources for this page

Verify at the official NPI Registry.