Kristie Michelle Grimes-Mallard, RN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN2335640 Issued in MA

Practice address

45 Dimock St
Roxbury, MA 02119-1208

Phone

(617) 442-8800

Fax

(617) 541-8334

NPI assigned

Jul 22, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dimock Community Health Center, Inc.Group PAC ID 7012810492, 43 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kgrimesmallard255526@direct.bilh.masshiway.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dimock Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Roxbury, MA
  • NPI 1588719488
  Medicare reassignment Care Compare group NPD
• Dimock Community Health Center, Inc

  • Community/Retail Pharmacy
  • Roxbury, MA
  • NPI 1023850120
  NPD

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

{
    "created_epoch": "1595376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605484800000",
    "number": "1730797077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 HOWE ST UNIT 1",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021252143",
            "telephone_number": "617-828-9941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 DIMOCK ST",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021191208",
            "telephone_number": "617-442-8800",
            "fax_number": "617-541-8334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMES-MALLARD",
        "first_name": "KRISTIE",
        "middle_name": "MICHELLE",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-22",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "RN2335640",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN2335640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110164451A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jourdan K Greene
• Paul Gregg
• Neddeidth E Gregory
• Shameka Gregory, LICSW
• Gabrielle Grier
• Danielle Drake Grimm, NP
• Dorothy Grooms
• Juan Grullon
• Claudette Guerrier
• Joane Guillet

• Nurse Practitioner in Roxbury, MA
• Providers in Roxbury, MA by specialty
• Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; 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.