Individual provider Active NPI

Paul Vincent Grimm, D.C.

  • Chiropractor
  • Merritt Island, FL
National Provider Identifier
1639215007
Registry record updated May 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH 8328 Issued in FL
Practice address
110 N Tropical TRL
Merritt Island, FL 32953-4737
Phone
(321) 459-9400
Fax
(321) 459-9422
NPI assigned
Jan 30, 2007
Last updated
May 20, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH 8328 FL Primary

Addresses

Primary practice location

110 N Tropical TRL
Merritt Island, FL 32953-4737

Mailing address

110 N Tropical TRL
Merritt Island, FL 32953-4737
Phone (321) 459-9400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040719000235 FL Practitioner - Chiropractic 9032198676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

110 N Tropical Trail
Merritt Island, FL 32953-4737
Phone (321) 459-9400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH 8328FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Chiropractic Health Clinic of Brevard PA Chiropractor CurrentSince Mar 1, 2004 Accepting new patients

Locations

110 N Tropical Trl
Merritt Island, FL 32953
Phone (321) 459-9400

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211241600000",
    "number": "1639215007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 N TROPICAL TRL",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329534737",
            "telephone_number": "321-459-9400",
            "fax_number": "321-459-9422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N TROPICAL TRL",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329534737",
            "telephone_number": "321-459-9400",
            "fax_number": "321-459-9422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMM",
        "first_name": "PAUL",
        "middle_name": "VINCENT",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2008-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH 8328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merritt Island, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.