Justin Grissom, AG-ACNP, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APN.0996720-NP Issued in CO

Practice address

3210 Gothic PL
Colorado Springs, CO 80917-4323

Phone

(719) 210-5633

NPI assigned

Aug 23, 2021

Last updated

Aug 23, 2021By 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

Enrolled in CO

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

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lutheran Hospital Association of the San Luis ValleyGroup PAC ID 4789589094, 146 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• San Luis Valley Regional Medical Center Hospital, Alamosa, CO, CCN 060008
• San Luis Valley Health Conejos County Hospital Hospital, La Jara, CO, CCN 061308
• Rio Grande Hospital Hospital, Del Norte, CO, CCN 061301

Merit-based Incentive Payment System (MIPS)

Final score

85.41 of 100Reported as group

Quality

70.25

Promoting interoperability

100

Improvement activities

40

Cost

67.83

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Lutheran Hospital Association of the San Luis Valley

  dba San Luis Valley Health Regional Medical Center

  • General Acute Care Hospital
  • Alamosa, CO
  • NPI 1235181744
  Medicare reassignment Care Compare group NPD

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

• Lutheran Hospital Association of the San Luis Valley

  dba SLV Health Conejos County Hospital

  • Critical Access Hospital Clinic/Center
  • La Jara, CO
  • NPI 1194792762
  Care Compare affiliation
• Lutheran Hospital Association of the San Luis Valley

  dba San Luis Valley Health Regional Medical Center

  • General Acute Care Hospital
  • Alamosa, CO
  • NPI 1235181744
  Care Compare affiliation
• Valley Citizens' Foundation for Health Care Inc

  dba Rio Grande Hospital

  • Critical Access Hospital
  • Del Norte, CO
  • NPI 1396783981
  Care Compare affiliation
• Valley Citizens' Foundation for Health Care Inc

  dba Rio Grande Hospital Clinic at South Fork

  • Critical Access Hospital Clinic/Center
  • South Fork, CO
  • NPI 1699266718
  Care Compare affiliation
• Valley Citizens' Foundation for Health Care Inc

  dba Creede Family Practice of Rio Grande Hospital

  • Critical Access Hospital Clinic/Center
  • Creede, CO
  • NPI 1851882989
  Care Compare affiliation

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

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1609542273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 GOTHIC PL",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809174323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3210 GOTHIC PL",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809174323",
            "telephone_number": "719-210-5633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISSOM",
        "first_name": "JUSTIN",
        "credential": "AG-ACNP, FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "APN.0996720-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; 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.