Stephanie Grondahl, DO

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

UO3557 Issued in FL

Practice address

1200 E Michigan Ave Ste 460
Lansing, MI 48912-1897

Phone

(517) 364-2097

Fax

(517) 364-3336

NPI assigned

Feb 2, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Stephanie Jarnagin Former name

Medicare fee-for-service enrollment

Enrolled in ND

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• Innovis Health, LLC

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1215125463
  Medicare reassignment NPD
• Innovis Health LLC

  • Multi-Specialty Clinic/Center
  • Fargo, ND
  • NPI 1144776576
  NPD
• Innovis Health LLC

  • Occupational Medicine Clinic/Center
  • Fargo, ND
  • NPI 1568918902
  NPD

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

{
    "created_epoch": "1391299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1760805352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 38TH AVE N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337101629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E MICHIGAN AVE STE 460",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489121897",
            "telephone_number": "517-364-2097",
            "fax_number": "517-364-3336"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6500 38th Ave N",
            "address_purpose": "LOCATION",
            "city": "St Petersburg",
            "state": "FL",
            "postal_code": "337101629",
            "country_code": "US",
            "telephone_number": "727-384-1414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRONDAHL",
        "first_name": "STEPHANIE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-02",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "UO3557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "JARNAGIN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Griffith Public Schools
• Abigail Katherine Grill
• Cassandra Lynn Grimes, NP
• David N Grimshaw, D.O.
• Muhammad Arbaz Griwal
• Barbara Groom, LLP
• Rebecca Gross
• Glenn Richard Grossman, L.AC., AC, CH NCCAOM
• Andesite Grossmeyer, LLMSW
• Robin Oberle Groszko, ACSW

• General Practice Physician in Lansing, MI
• Providers in Lansing, MI by specialty
• General Practice Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.