Thomas J Grube, MD
Individual provider Active NPI Ophthalmology Physician · Mandan, ND
NPI 1659328516 · NPPES record last updated Aug 18, 2010
Key facts
- NPI
- 1659328516
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Ophthalmology Physician 207W00000X
- License
- 9201 (ND)
- Practice address
- 107 3Rd Ave NW
Mandan, ND 58554-3129 - Phone
- (701) 751-2131
- Fax
- (701) 751-2133
- NPI assigned
- May 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050727000097 | ND | Practitioner - Ophthalmology | 6002844511 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9201 | ND | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grube Retina Clinic PC | Ophthalmology | Current |
Accepting new patients |
| Audrey E. Fields, O.D. & Associates, P.C. | Past | Accepting new patients | |
| Retina Consultants, LTD | Ophthalmology | Past |
Accepting new patients |
| Dakota Eye Institute PC | Ophthalmology | Past | Accepting new patients |
| Dakota Surgery & Laser Center LLC | Past |
Accepting new patients | |
| Frances Mahon Deaconess Hospital | Past | Accepting new patients |
Locations
2273 3rd Ave W
Dickinson, ND 58601
Phone (701) 225-7886
107 3rd Ave NW
Mandan, ND 58554
Phone (701) 222-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 9201 | ND | Yes |
| Surgery Physician | 208600000X | 9201 | ND |
Addresses
Primary practice location
107 3Rd Ave NW
Mandan, ND 58554-3129
Mailing address
1514 Buccaneer PL
Bismarck, ND 58504-8982
Phone (701) 250-6820
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12035 | Medicaid | ND |
Other providers in Mandan, ND
- Faith Gress
- Hannah Gress
- Peter Joseph Gress
- Alicia Grimm
- Grube Retina Clinic PC
- John M Grunseth
- Guardian Angels Homecare
- Joann Guerard
- H.I.P.P Kids Therapy PLC
- Joshua James Hadsell
All providers in Mandan, ND · Ophthalmology Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.