Ruby Griswold

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA61489588 Issued in WA

Practice address

4311 11TH Ave NE Ste 200
Seattle, WA 98105-6367

Phone

(206) 616-4001

NPI assigned

Sep 7, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Seattle Children'S Hospital

  • Specialist
  • Seattle, WA
  • NPI 1003319500
  Medicare reassignment
• Seattle Children'S Hospital

  • Children's Hospital
  • Seattle, WA
  • NPI 1467536276
  NPD
• Seattle Childrens Hospital

  • Clinic Pharmacy
  • Seattle, WA
  • NPI 1245342153
  NPD
• Providence Health & Services-Wa

  • General Acute Care Hospital
  • Everett, WA
  • NPI 1700037801
  NPD (past)
• Providence Health & Services-Wa

  • Pediatric Nurse Practitioner
  • Everett, WA
  • NPI 1790936185
  NPD (past)
• Seattle Children'S Hospital

  • Home Infusion Agency
  • Bothell, WA
  • NPI 1245383348
  NPD (past)

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

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1346961471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4311 11TH AVE NE STE 200",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981056367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4311 11TH AVE NE STE 200",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981056367",
            "telephone_number": "206-616-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISWOLD",
        "first_name": "RUBY",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-07",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61489588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Mary Grissom, L.AC.
• Kenrodric Grissom
• Kimberly Grissom
• Anna Brown Griswold, LMHCA
• Cassia Rae Griswold, PHARMD
• Kendra Metz Gritsch, MSW, LSWAIC
• Jamie Gritzan
• Petros Grivas, M.D.
• Lascelle Clarence Grizzle, REGISTERED NURSE
• Carolyn Margaret Grob, M.A.

• Physician Assistant in Seattle, WA
• Providers in Seattle, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.