Madison L Grinnell, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

9334 Issued in NE

Practice address

Lauritzen Outpatient Center
4014 Leavenworth St
Omaha, NE 68105

Phone

(800) 922-0000

NPI assigned

Dec 13, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

University of Nebraska College of Medicine, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1639353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687478400000",
    "number": "1649939109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4911 CALIFORNIA ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681322417",
            "telephone_number": "402-290-4246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "LAURITZEN OUTPATIENT CENTER",
            "address_2": "4014 LEAVENWORTH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68105",
            "telephone_number": "800-922-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRINNELL",
        "first_name": "MADISON",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-13",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NE",
            "license": "9334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniela Grinan
• Gunther Grinde
• Katelin Ruby Grinde
• Daniel Grindstaff, M.D.
• Terry Lee Grindstaff Jr., PT, ATC
• Arthur Grinstead, MD
• Amara Grisedale
• Dana Grisham
• Terina Grissett
• Bryndis Grissom, DO

• Dermatology Physician in Omaha, NE
• Providers in Omaha, NE by specialty
• Dermatology Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2023; 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.