Individual provider Active NPI

Robert Steven Grittmann, DO

  • Internal Medicine Physician
  • Waterloo, IA
National Provider Identifier
1689707291
Registry record updated Jul 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2031 Issued in IA
Practice address
2055 Kimball Ave
Suite 320
Waterloo, IA 50702-5014
Phone
(319) 272-2340
Fax
(319) 272-2347
NPI assigned
Mar 13, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2031 IA Primary

Addresses

Primary practice location

2055 Kimball Ave
Suite 320
Waterloo, IA 50702-5014

Mailing address

2055 Kimball Ave
Suite 320
Waterloo, IA 50702-5014
Phone (319) 272-2340

Other identifiers 1

IdentifierTypeStateIssuer
2031146MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20100306000058 IA Practitioner - Internal Medicine 6709850357 Practice locations: Hudson, IA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2031IAMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280188800000",
    "number": "1689707291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2055 KIMBALL AVE",
            "address_2": "SUITE 320",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025014",
            "telephone_number": "319-272-2340",
            "fax_number": "319-272-2347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 KIMBALL AVE",
            "address_2": "SUITE 320",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025014",
            "telephone_number": "319-272-2340",
            "fax_number": "319-272-2347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRITTMANN",
        "first_name": "ROBERT",
        "middle_name": "STEVEN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2010-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "2031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2031146",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

Verify at the official NPI Registry.