NPIMap

Individual provider Active NPI

Nicholas Joseph Grinnell, PA-C

  • Physician Assistant
  • Sequim, WA
National Provider Identifier
1568198224
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA61309930 Issued in WA
Practice address
808 N 5TH Ave
Sequim, WA 98382-3045
Phone
(360) 683-5900
NPI assigned
Jul 26, 2022
Last updated
Jul 26, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA61309930 WA Primary

Addresses

Primary practice location

808 N 5TH Ave
Sequim, WA 98382-3045

Mailing address

81 Streit Rd
Sequim, WA 98382-7553
Phone (360) 461-1133

Other identifiers 1

IdentifierTypeStateIssuer
PA61309930OtherWAPROVIDER CREDENTIAL NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20220818001570 WA Practitioner - Physician Assistant 1254714595 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
George Washington University School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jamestown S'Klallam TribeGroup PAC ID 2365349495, 38 clinicians

Practice addresses (Care Compare)

526 S 9TH Ave
Sequim, WA 98382-3626
Phone (360) 683-5900

808 N 5TH Ave
Sequim, WA 98382-3045
Phone (360) 683-5900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Jamestown S'Klallam Tribe CurrentSince Sep 1, 2022 Accepting new patients

Locations

526 S 9th Ave
Sequim, WA 98382
Phone (360) 681-7755

808 N 5th Ave
Sequim, WA 98382
Phone (360) 582-4840

Organizations & group practices 2

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 6

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": "1658793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658793600000",
    "number": "1568198224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 STREIT RD",
            "city": "SEQUIM",
            "state": "WA",
            "postal_code": "983827553",
            "telephone_number": "360-461-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 N 5TH AVE",
            "city": "SEQUIM",
            "state": "WA",
            "postal_code": "983823045",
            "telephone_number": "360-683-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRINNELL",
        "first_name": "NICHOLAS",
        "middle_name": "JOSEPH",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-26",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61309930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER CREDENTIAL NUMBER",
            "identifier": "PA61309930",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sequim, WA

Sources for this page

Verify at the official NPI Registry.