Kimberly Ann Grzybowski, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP019532 Issued in PA

Practice address

1020 W Lackawanna Ave
Scranton, PA 18504-2052

Phone

(570) 904-6000

Fax

(570) 871-4638

NPI assigned

Nov 13, 2018

Last updated

Oct 9, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Kimberly Ann Marusin Former name

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Cleanslate Medical Group of Pennsylvania LLCGroup PAC ID 8426334400, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Cleanslate Medical Group of Pennsylvania LLC

  • Multi-Specialty Clinic/Center
  • Wilkes Barre, PA
  • NPI 1184177263
  Medicare reassignment Care Compare group NPD
• Rural Health Corporation of Northeastern Pennsylvania

  • Federally Qualified Health Center (FQHC)
  • Wilkes Barre, PA
  • NPI 1265801112
  Medicare reassignment NPD
• Rural Health Corporation of Northeastern Pennsylvania

  • Federally Qualified Health Center (FQHC)
  • Wilkes Barre, PA
  • NPI 1437351640
  NPD

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

{
    "created_epoch": "1542067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1689142283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 PEACEFUL VALLEY RD",
            "city": "SCOTT TWP",
            "state": "PA",
            "postal_code": "184119761",
            "telephone_number": "570-351-3424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 W LACKAWANNA AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185042052",
            "telephone_number": "570-904-6000",
            "fax_number": "570-871-4638"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "39 E Jackson St",
            "address_purpose": "LOCATION",
            "city": "Wilkes Barre",
            "state": "PA",
            "postal_code": "187012709",
            "country_code": "US",
            "telephone_number": "570-704-4145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRZYBOWSKI",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-13",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP019532",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP019532",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "PA",
            "license": "SP019532",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "MARUSIN",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cortney Grubbs, LCSW
• Blanche Durand Grube, D.M.D
• John Henry Grube, DC
• Tom X Grudis, OPTICIAN
• Rita Marie Grudzinski, LMT
• Sivanne Guenoun, LMT
• Jaya Gujjarlapudi
• Muhammad Hamza Gul, MBBS
• Edvard Adrian Gumbs, M.D.
• Juanita Gundry, LMT

• Family Nurse Practitioner in Scranton, PA
• Providers in Scranton, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; 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.