Active NPI
Bridget Grimes
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Kenosha, WI
National Provider Identifier
1679112072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- License
- 2166-39
- Practice address
- 8560 26TH Ave
Kenosha, WI 53143-6447 - Phone
- (920) 207-7904
- NPI assigned
- Jan 2, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 2166-39 | WI | Primary |
Addresses
Primary practice location
8560 26TH Ave
Kenosha, WI 53143-6447
Mailing address
8527 N 60TH St
Brown Deer, WI 53223-2801
Phone (920) 207-7904
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2166-39 | WI | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577923200000",
"number": "1679112072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8527 N 60TH ST",
"city": "BROWN DEER",
"state": "WI",
"postal_code": "532232801",
"telephone_number": "920-207-7904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8560 26TH AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531436447",
"telephone_number": "920-207-7904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMES",
"first_name": "BRIDGET",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-02",
"last_updated": "2020-01-02",
"certification_date": "2020-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "WI",
"license": "2166-39",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.