William Anthony Gromko, M.D.
Individual provider Active NPI Family Medicine Physician · Sandy, OR
NPI 1477565026 · NPPES record last updated May 11, 2021
Key facts
- NPI
- 1477565026
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD204079 (OR)
- Practice address
- 17055 Ruben LN
Sandy, OR 97055-9276 - Phone
- (503) 668-8002
- Fax
- (503) 668-5246
- NPI assigned
- Aug 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Creighton University School of Medicine, 1974
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Family Health and Wellness Inc
Practice addresses (Care Compare)
108 E 9TH St
Suite 1
Libby, MT 59923-2019
Phone (706) 293-3113
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN, MT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200210001154 | MN | Practitioner - Family Practice | 8325189996 | Reassigns benefits to 1 organization |
| I20201113001393 | MT | Practitioner - Family Practice | 8325189996 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD204079 | OR | MD | Family Medicine Physician |
| 14461 | WA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Group Health, Inc. | Current |
Accepting new patients | |
| Group Health, Inc. | Current |
Accepting new patients | |
| Family Health & Wellness, Inc. | Current |
Accepting new patients | |
| Group Health, Inc. | Current | Accepting new patients |
Locations
8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600
8170 33rd Ave S
Minneapolis, MN 55425
Phone (952) 883-5463
2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600
8450 Seasons Pkwy
Woodbury, MN 55125
Phone (651) 702-5300
34169 US Highway 2
Ste 1
Libby, MT 59923
350 Louisiana Ave
Libby, MT 59923
Phone (406) 283-7000
34169 US Highway 2
Libby, MT 59923
Phone (406) 293-3113
108 E 9th St
Ste 1
Libby, MT 59923
Phone (406) 293-3113
Interoperability endpoints
- william.gromko@330576480108548.direct.elationemr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 14461 | WA | |
| Family Medicine Physician | 207Q00000X | 66750 | MN | |
| Family Medicine Physician | 207Q00000X | MD204079 | OR | Yes |
Addresses
Primary practice location
17055 Ruben LN
Sandy, OR 97055-9276
Mailing address
17055 Ruben LN
Sandy, OR 97055-9276
Phone (503) 668-8002
Other practice location 1
360 Lilly Rd NE Ste B
Olympia, WA 98506-5430
Phone (360) 491-8100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 147208 | Other | WA | WORKERS COMPENSATION |
| 7280GR | Other | WA | BLUE CROSS BLUE SHIELD |
| 1112713 | Medicaid | WA | |
| 080168652 | Other | WA | PALMETTO GBA |
| 610278200 | Other | WA | U.S. DEPT. OF LABOR |
| 912107280985030000 | Other | WA | TRICARE |
Other providers in Sandy, OR
- Agaiby George
- Hannah Glaser
- Brianna R. Gover
- Jason M Gray
- Gresham Vision Center, Inc
- Victoria Elizabeth Guinn
- Amy R Haase
- Crystal Anne Hall
- Ernest E Hamilton
- Melissa Ruth Harbert
All providers in Sandy, OR · Family Medicine Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.