Andrea Tomasek Grimball, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA0000001561 Issued in TN

Practice address

27 Medical Center Dr
Jackson, TN 38301-3949

Phone

(731) 424-1001

NPI assigned

Oct 4, 2006

Last updated

Mar 24, 2009By 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 2

Addresses

Other identifiers 4

Other names 1

• Andrea Dawn Tomasek Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237852800000",
    "number": "1427144997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 MEDICAL CENTER DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013949",
            "telephone_number": "731-424-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 MEDICAL CENTER DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013949",
            "telephone_number": "731-424-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMBALL",
        "first_name": "ANDREA",
        "middle_name": "TOMASEK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2009-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101918",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "PA0000001561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970023893",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ALABAMA",
            "identifier": "059051687",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291182500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009976550",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "TOMASEK",
            "middle_name": "DAWN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Greystone Medical Clinic, P.C.
• Billie Suanne Griffin, M.A., CCC-SLP
• Jenna R Griffin, D.N.P.
• Robbie Griffin, APN
• Rebecca A Griggs Galyean, DNP
• Arthur Grimball, M.D.
• Matthew Grinder, LPC/MHSP
• Hilary C. Grissom, M.D.
• Emma Beth Griswell
• Michele Grogan Baker, LMT

• Physician Assistant in Jackson, TN
• Providers in Jackson, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.

Verify at the official NPI Registry.