Active NPI
Wendell Ellis Grimes, D.D.S.
- Dentist
- Baker, LA
National Provider Identifier
1720036221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4696
- Practice address
- 1806 Main St
Baker, LA 70714-2842 - Phone
- (225) 775-1388
- Fax
- (225) 775-1344
- NPI assigned
- May 5, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 4696 | LA | Primary |
Addresses
Primary practice location
1806 Main St
Baker, LA 70714-2842
Mailing address
3141 Adams St
Baker, LA 70714-2801
Phone (225) 775-1388
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170207000159 | LA | Order and Referring Only - Dentist | 7719260363 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473638400000",
"number": "1720036221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3141 ADAMS ST",
"city": "BAKER",
"state": "LA",
"postal_code": "707142801",
"telephone_number": "225-775-1388",
"fax_number": "225-775-1344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1806 MAIN ST",
"city": "BAKER",
"state": "LA",
"postal_code": "707142842",
"telephone_number": "225-775-1388",
"fax_number": "225-775-1344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMES",
"first_name": "WENDELL",
"middle_name": "ELLIS",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-05",
"last_updated": "2016-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "LA",
"license": "4696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baker, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2016; 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.