Individual provider Active NPI

Adrienne Katrice Grimmett, DDS

  • General Practice Dentistry
  • Clearwater, FL
National Provider Identifier
1386798601
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901017950 Issued in MI
Practice address
14100 58TH St N
Clearwater, FL 33760-9900
Phone
(727) 824-8181
Fax
(727) 824-8165
NPI assigned
Jan 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901017950 MI Primary

Addresses

Primary practice location

14100 58TH St N
Clearwater, FL 33760-9900

Mailing address

14100 58TH St N
Clearwater, FL 33760-9900
Phone (727) 824-8181

Other identifiers 1

IdentifierTypeStateIssuer
4886099MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161003000777 MI Order and Referring Only - DentistPractitioner - Dentist 1456530948

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901017950MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Center Inc Current Accepting new patients

Locations

117 W Paterson St
Kalamazoo, MI 49007

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1386798601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14100 58TH ST N",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337609900",
            "telephone_number": "727-824-8181",
            "fax_number": "727-824-8165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14100 58TH ST N",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337609900",
            "telephone_number": "727-824-8181",
            "fax_number": "727-824-8165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMMETT",
        "first_name": "ADRIENNE",
        "middle_name": "KATRICE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901017950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4886099",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

Verify at the official NPI Registry.