Steven M Groddy, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

4077 Issued in WI

Practice address

1503 Randolph CT
Manitowoc, WI 54220-8345

Phone

(920) 682-0321

Fax

(920) 682-3128

NPI assigned

Aug 23, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: sgroddy293906@direct.ochin.org

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.

• Dental Park SC

  • Dental Clinic/Center
  • Manitowoc, WI
  • NPI 1386636959
  NPD (past)

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699768853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 RANDOLPH CT",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542208345",
            "telephone_number": "920-682-0321",
            "fax_number": "920-682-3128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 RANDOLPH CT",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542208345",
            "telephone_number": "920-682-0321",
            "fax_number": "920-682-3128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRODDY",
        "first_name": "STEVEN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "4077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33712900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danalee J Gray, HIS
• Paul Robert Gray
• Bob H Greene, M.D.
• Naomi Marie Grimm, OTR
• Megan Grimmenga, PHARMD
• Jennifer Groehler
• Stephanie Wise Grosvenor, D.O.
• Andrew Ryan Grote, RPH
• Terry Gueldner, MD
• Jacqueline Guyette

• Dentist in Manitowoc, WI
• Providers in Manitowoc, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.