Active NPI
Kim Marie Grum, LSUDC, CAADC, CRS
- Addiction (Substance Use Disorder) Counselor
- Las Vegas, NV
National Provider Identifier
1649271933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 13939693
- Practice address
- 2512 Golden Sands Dr
Las Vegas, NV 89128-6801 - Phone
- (215) 919-1558
- Fax
- (215) 491-1750
- NPI assigned
- Aug 9, 2005
- Last updated
- Jan 24, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 13939693 | UT | Primary |
Addresses
Primary practice location
2512 Golden Sands Dr
Las Vegas, NV 89128-6801
Mailing address
2512 Golden Sands Dr
Las Vegas, NV 89128-6801
Phone (215) 919-1558
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0284366000 | Other | PA | INDEPENDENCE BLUE CROSS |
| 07802520 | Medicaid | PA | |
| 1649271933 | Medicaid | UT | |
| 447982 | Other | PA | HIGHMARK BLUE SHIELD |
| 1015164 | Other | PA | KEYSTONE MERCY |
Other names 1
- Dr. Kim Marie Abdalla-Digiacomo
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13939693 | UT | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737676800000",
"number": "1649271933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2512 GOLDEN SANDS DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891286801",
"telephone_number": "215-919-1558",
"fax_number": "215-491-1750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2512 GOLDEN SANDS DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891286801",
"telephone_number": "215-919-1558",
"fax_number": "215-491-1750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRUM",
"first_name": "KIM",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "LSUDC, CAADC, CRS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-08-09",
"last_updated": "2025-01-24",
"certification_date": "2025-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "UT",
"license": "13939693",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENCE BLUE CROSS",
"identifier": "0284366000",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "07802520",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1649271933",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BLUE SHIELD",
"identifier": "447982",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE MERCY",
"identifier": "1015164",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KIM",
"last_name": "ABDALLA-DIGIACOMO",
"middle_name": "MARIE",
"prefix": "DR.",
"credential": "DPM",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.