Cynthia Mae Wilson Grillo, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

152581 Issued in MA

Practice address

100 South St
Suite 102
Southbridge, MA 01550-4051

Phone

(508) 764-3194

Fax

(508) 765-5458

NPI assigned

Jul 31, 2006

Last updated

Feb 1, 2012By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Adventist Health Clearlake Hospital Inc.

  dba Adventist Health Clear Lake

  • Critical Access Hospital
  • Clearlake, CA
  • NPI 1124018031
  Medicare reassignment NPD
• Adventist Health Physicians Network

  • Multi-Specialty Clinic/Center
  • Hanford, CA
  • NPI 1063718583
  Medicare reassignment NPD
• Adventist Health Physicians Network

  • Physical Therapy Clinic/Center
  • Paradise, CA
  • NPI 1134092190
  NPD
• Adventist Health Physicians Network

  • Physical Therapist
  • Chico, CA
  • NPI 1649835778
  NPD
• Harrington Memorial Hospital

  • General Acute Care Hospital
  • Southbridge, MA
  • NPI 1992787774
  NPD (past)
• Adventist Health Clearlake Hospital, Inc

  dba Adventist Health Clear Lake

  • Rural Health Clinic/Center
  • Lakeport, CA
  • NPI 1871063040
  NPD (past)

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328054400000",
    "number": "1366458457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SOUTH ST",
            "address_2": "SUITE 102",
            "city": "SOUTHBRIDGE",
            "state": "MA",
            "postal_code": "015504051",
            "telephone_number": "508-764-3194",
            "fax_number": "508-765-5458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SOUTH ST",
            "address_2": "SUITE 102",
            "city": "SOUTHBRIDGE",
            "state": "MA",
            "postal_code": "015504051",
            "telephone_number": "508-764-3194",
            "fax_number": "508-765-5458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON GRILLO",
        "first_name": "CYNTHIA",
        "middle_name": "MAE",
        "name_prefix": "Ms.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2012-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "152581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220019",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher William Wellspeak, PHARMD
• Wheels on the Bus Transportation LLC
• Michaela White, RDN, LDN
• Godfred Darfour Williams
• Heather Lynne Williams
• Pamela Anne Wilson, D.O. FACOP
• William Witherspoon
• Brian E Wolf, M.D.
• Rebecca Woloski, OT/R
• Lindsay Wood

• Pediatrics Physician in Southbridge, MA
• Providers in Southbridge, MA by specialty
• Pediatrics Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; 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.