NPIMap

Individual provider Active NPI

Rodney E Grolman, MD

  • Surgery Physician
  • Moses Lake, WA
National Provider Identifier
1457340986
Registry record updated Aug 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD60050963 Issued in WA
Practice address
1550 S Pioneer Way
Suite 370
Moses Lake, WA 98837-4613
Phone
(410) 218-8059
NPI assigned
Oct 18, 2005
Reactivated
May 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X C53617 CA
Surgery Physician 208600000X MD60050963 WA Primary

Addresses

Primary practice location

1550 S Pioneer Way
Suite 370
Moses Lake, WA 98837-4613

Mailing address

1550 S Pioneer Way
Suite 370
Moses Lake, WA 98837-4613
Phone (410) 218-8059

Other identifiers 7

IdentifierTypeStateIssuer
1334455OtherMDAETNA HMO
402277700MedicaidMD
145724700OtherMDFEDERAL WORKMAN'S COMP
887BAA62011004OtherMDCAREFIRST
K5850005OtherDCCAREFIRST DC
P00354284OtherMDRR MEDICARE
7843490OtherMDAETNA PPO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090821000533 CA Practitioner - General Surgery 3971566522 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

2850 Telegraph Ave
Suite 120
Berkeley, CA 94705-1159
Phone (510) 204-8150

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
53617CAMDMarriage & Family Therapist
MD60050963WAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Aug 1, 2017 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Aug 1, 2017 Accepting new patients
Central California Inpatient Physicians Surgery Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients
Emergency and Acute Care Medical Corporation PastSince Jan 14, 2024 Accepting new patients
Acute Care Surgery Medical Group, Inc. Surgery Past Accepting new patients
Grant County Public Hospital District 1 Past Accepting new patients
Alta Bates Summit Medical Center Past Accepting new patients
Rodney E. Grolman, M.D., P.a. Surgery Past Accepting new patients
St. Agnes Healthcare, Inc. Past Accepting new patients
Grant County Public Hospital District 1 Past Accepting new patients

Locations

2850 Telegraph Ave
Ste 120
Berkeley, CA 94705
Phone (510) 204-8140

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

3687 Mt Diablo Blvd
Ste 200
Lafayette, CA 94549
Phone (510) 204-6660

23625 Wr Holman Hwy
Monterey, CA 93940
Phone (831) 622-2708

365 Hawthorne Ave
Ste 301
Oakland, CA 94609
Phone (510) 204-8168

12 Camino Encinas
Orinda, CA 94563
Phone (510) 204-8180

795 El Camino Real
#1112
Palo Alto, CA 94301

Interoperability endpoints

  • Direct secure messaging: rgrolmanmd30515@hisp.ehr.sutterhealth.org

Organizations & group practices 11

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375747200000",
    "number": "1457340986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 S PIONEER WAY",
            "address_2": "SUITE 370",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988374613",
            "telephone_number": "410-218-8059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 S PIONEER WAY",
            "address_2": "SUITE 370",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988374613",
            "telephone_number": "410-218-8059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROLMAN",
        "first_name": "RODNEY",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2013-08-06",
        "deactivation_date": "2005-10-25",
        "reactivation_date": "2007-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "C53617",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD60050963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "1334455",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402277700",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL WORKMAN'S COMP",
            "identifier": "145724700",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "887BAA62011004",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST DC",
            "identifier": "K5850005",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00354284",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "7843490",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moses Lake, WA

Sources for this page

Verify at the official NPI Registry.