Active NPI
James Grimm
- Child & Adolescent Psychiatry Physician
- Eugene, OR
National Provider Identifier
1407929565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 19133
- Practice address
- 1926 Potter St
Eugene, OR 97405-3060 - Phone
- (541) 221-9007
- Fax
- (888) 541-9007
- NPI assigned
- Nov 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 19133 | OR | Primary |
Addresses
Primary practice location
1926 Potter St
Eugene, OR 97405-3060
Mailing address
1926 Potter St
Eugene, OR 97405-3060
Phone (541) 357-8007
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 130703 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19133 | OR | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256860800000",
"number": "1407929565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1926 POTTER ST",
"city": "EUGENE",
"state": "OR",
"postal_code": "974053060",
"telephone_number": "541-357-8007",
"fax_number": "888-541-9007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1926 POTTER ST",
"city": "EUGENE",
"state": "OR",
"postal_code": "974053060",
"telephone_number": "541-221-9007",
"fax_number": "888-541-9007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMM",
"first_name": "JAMES",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-16",
"last_updated": "2009-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "OR",
"license": "19133",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "130703",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.