Individual provider Active NPI

Kathryn Grunenwald, DMD

  • Pediatric Dentistry
  • Columbus, OH
National Provider Identifier
1497400584
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
30.027352 Issued in OH
Practice address
380 Butterfly Gardens Dr
Columbus, OH 43215-7508
Phone
(614) 722-5650
NPI assigned
Feb 16, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 30.027352 OH
Pediatric Dentistry 1223P0221X 30.027352 OH Primary

Addresses

Primary practice location

380 Butterfly Gardens Dr
Columbus, OH 43215-7508

Mailing address

380 Butterfly Gardens Dr
Columbus, OH 43215-7508

Other practice location 1

700 Childrens Dr
Columbus, OH 43205-2664
Phone (614) 722-2000

Other identifiers 1

IdentifierTypeStateIssuer
0007247MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241015002813 IL Practitioner - Dentist 6002348067 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30.027352OHMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Lawndale Christian Health Center Current Accepting new patients
Lawndale Christian Health Center CurrentSince Sep 9, 2024 Accepting new patients
Lawndale Christian Health Center CurrentSince Sep 9, 2024 Accepting new patients

Locations

3860 W Ogden Ave
Chicago, IL 60623
Phone (872) 588-3000

4696 Paysphere Cir
Chicago, IL 60674

Interoperability endpoints

  • Direct secure messaging: kgrunenwald728885@direct.ochin.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1644969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1497400584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 BUTTERFLY GARDENS DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432157508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 BUTTERFLY GARDENS DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432157508",
            "telephone_number": "614-722-5650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 Childrens Dr",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432052664",
            "country_code": "US",
            "telephone_number": "614-722-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRUNENWALD",
        "first_name": "KATHRYN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-16",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.027352",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OH",
            "license": "30.027352",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0007247",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.