Andrew Griscom, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

34668 Issued in CT

Practice address

111 Brewster St
Department of Emergency Medicine
Pawtucket, RI 02860-4400

Phone

(401) 729-2191

Fax

(401) 729-2517

NPI assigned

Nov 25, 2005

Last updated

May 15, 2023By the provider in NPPES

Sex

Male

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 2

Medicare fee-for-service enrollment

Enrolled in CT, VT2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Emergency Medicine

Education

Jefferson Medical College of Thomas Jefferson University, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cep America LLCGroup PAC ID 6608056171, 995 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Johnson Memorial Hospital Hospital, Stafford Springs, CT, CCN 070008

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: agriscom2442794@direct.trinity-health.org

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.

• Cep America LLC

  • Emergency Medicine Physician
  • Waterbury, CT
  • NPI 1700681202
  Medicare reassignment Care Compare group NPD
• Emergency Care Services of Connecticut, P.C.

  • Emergency Medicine Physician
  • Manchester, CT
  • NPI 1518519461
  Medicare reassignment NPD
• Nes Medical Services of Northern Connecticut, P.C.

  • Emergency Medicine Physician
  • Putnam, CT
  • NPI 1447231865
  Medicare reassignment NPD
• Trinity Health of New England Provider Network Organization Inc

  dba Trinity Health Of New England Medical Group

  • Internal Medicine Physician
  • Hartford, CT
  • NPI 1003882812
  Medicare reassignment NPD
• Cep America LLC

  • Emergency Medicine Physician
  • Stafford Springs, CT
  • NPI 1427853936
  NPD
• Cep America LLC

  • Emergency Medicine Physician
  • Fort Lauderdale, FL
  • NPI 1700747946
  NPD
• Nes Medical Services of Northern Connecticut, P.C.

  • Emergency Medicine Physician
  • Stafford Springs, CT
  • NPI 1194450478
  NPD
• Trinity Health of New England Provider Network Organization Inc

  dba Trinity Health Of New England Medical Group

  • Internal Medicine Physician
  • Waterville, ME
  • NPI 1134779531
  NPD
• North Stonington Health Center, Inc

  • General Practice Physician
  • North Stonington, CT
  • NPI 1396050209
  NPD (past)

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

• Johnson Memorial Hospital, Inc.

  • Psychiatric Hospital Unit
  • Stafford Springs, CT
  • NPI 1053480293
  Care Compare affiliation
• Johnson Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Stafford Springs, CT
  • NPI 1932123569
  Care Compare affiliation
• Johnson Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Stafford Springs, CT
  • NPI 1972728442
  Care Compare affiliation

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1538142328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 BREWSTER ST",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028604400",
            "telephone_number": "401-729-2191",
            "fax_number": "401-729-2517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 BREWSTER ST",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028604400",
            "telephone_number": "401-729-2191",
            "fax_number": "401-729-2517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISCOM",
        "first_name": "ANDREW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-25",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "RI",
            "license": "MD09664",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CT",
            "license": "34668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7006158",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "007061007",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Gerard Gregory, LICSW
• Wendy Grennan, MASTERS
• Renee Gribbin, ACDP
• Iulia C. Grillo, MD
• Guy Robert Grinsell, DC
• Diana Guerrier, MSW,LCSW
• Amber Gul, M.D.
• Priya Sarin Gupta, M.D.
• Melinda Gushwa, PHD, MSW
• Tracy Elaine Gustafson, MA

• Emergency Medicine Physician in Pawtucket, RI
• Providers in Pawtucket, RI by specialty
• Emergency Medicine Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.