Amber Grimm, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9112838 Issued in FL

Practice address

1337 S International Pkwy Ste 1301
Lake Mary, FL 32746-1402

Phone

(407) 878-0022

NPI assigned

Dec 16, 2019

Sex

Female

Sole proprietor

Yes

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

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Burgundy Prime IncGroup PAC ID 3870835507, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Burgundy Prime Inc

  • Psychiatry Physician
  • Lake Mary, FL
  • NPI 1720557150
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1576454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1609414143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1337 S INTERNATIONAL PKWY STE 100",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327461402",
            "telephone_number": "407-878-0022",
            "fax_number": "888-815-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1337 S INTERNATIONAL PKWY STE 1301",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327461402",
            "telephone_number": "407-878-0022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMM",
        "first_name": "AMBER",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-16",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Griffin Behavioral Solutions, LLC
• Sean Griffin, DPM
• Donna Michelle Griffith
• Andrew Griffiths
• Zulma Grijalba, RMHCI
• Challis Amanda Beven Grimm, ARNP
• Michael Harris Grocholski, D.C.
• Edward John Gross, M.D.
• Sharon Lee Gross, PT
• Annika Lou Gudel

• Physician Assistant in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; 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.