Phillip Michael Grob, M. D.

Primary specialty

Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X

License

G85079 Issued in CA

Practice address

339 College Ave
Santa Rosa, CA 95401-5117

Phone

(707) 573-0223

Fax

(707) 573-0222

NPI assigned

Dec 13, 2006

Last updated

Jul 8, 2014By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2024 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• University of Maryland Psychiatry Associates, PA

  dba Psychiatry Associates, PA

  • Psychiatry Physician
  • Baltimore, MD
  • NPI 1649292699
  NPD (past)

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404777600000",
    "number": "1588725253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3322 CHANATE RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954041708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 COLLEGE AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954015117",
            "telephone_number": "707-573-0223",
            "fax_number": "707-573-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROB",
        "first_name": "PHILLIP",
        "middle_name": "MICHAEL",
        "credential": "M. D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2014-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "CA",
            "license": "G85079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sydney Griffin, MA
• Gary Grill, DDS
• Suzanna Jean Grill
• Lenora Marie Grimando, MFT
• Naomi Grimm
• Gregory Lorne Groeneveld, CRNA
• Vera June Groff, CMT
• Yolanda Amada Grose
• Courtney Gross
• Emily Ann Gross, CAADE MEMBER

• Geriatric Psychiatry Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Geriatric Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.