Active NPI
Kim D Grymaloski, M.D.
- Family Medicine Physician
- Worthington, MN
National Provider Identifier
1487651782
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 41903
- Practice address
- 1680 Diagonal Rd
Worthington, MN 56187-1008 - Phone
- (507) 372-3800
- Fax
- (507) 372-3806
- NPI assigned
- Jun 30, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 41903 | MN | Primary |
Addresses
Primary practice location
1680 Diagonal Rd
Worthington, MN 56187-1008
Mailing address
PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-9556
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41903 | MN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193011200000",
"number": "1487651782",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5074",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571175074",
"telephone_number": "605-328-9556",
"fax_number": "605-328-9501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1680 DIAGONAL RD",
"city": "WORTHINGTON",
"state": "MN",
"postal_code": "561871008",
"telephone_number": "507-372-3800",
"fax_number": "507-372-3806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRYMALOSKI",
"first_name": "KIM",
"middle_name": "D",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-30",
"last_updated": "2007-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "41903",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worthington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.