Active NPI
Gary Grimm
- Family Nurse Practitioner
- Honolulu, HI
National Provider Identifier
1386293249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- SP020636
- Practice address
- 459 Patterson Rd
Honolulu, HI 96819-1522 - Phone
- (808) 433-0600
- NPI assigned
- Sep 4, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | SP020636 | PA | Primary |
Addresses
Primary practice location
459 Patterson Rd
Honolulu, HI 96819-1522
Mailing address
459 Patterson Rd
Honolulu, HI 96819-1522
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220222000270 | PA | Order and Referring Only - Nurse Practitioner | 3072907807 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP020636 | PA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717632000000",
"number": "1386293249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "459 PATTERSON RD",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968191522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "459 PATTERSON RD",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968191522",
"telephone_number": "808-433-0600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMM",
"first_name": "GARY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-04",
"last_updated": "2024-06-06",
"certification_date": "2024-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "PA",
"license": "SP020636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Honolulu, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; 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.