Jonathan W Grymaloski, M.D.
Individual provider Active NPI Family Medicine Physician · Everson, WA
NPI 1790782209 · NPPES record last updated May 30, 2024
Key facts
- NPI
- 1790782209
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD60051086 (WA)
- Practice address
- 6884 Hannegan Rd
Everson, WA 98247-9637 - Phone
- (360) 354-0766
- Fax
- (360) 357-7667
- NPI assigned
- Jun 30, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sea Mar Community Health Centers
Practice addresses (Care Compare)
4455 Cordata Pkwy
Bellingham, WA 98226-8037
Phone (360) 671-3225
6884 Hannegan Rd
Everson, WA 98247-9637
Phone (360) 354-0766
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090715000486 | WA | Practitioner - Family Practice | 8820044894 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD60051086 | WA | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sea Mar Community Health Centers | Family Medicine | Current | Accepting new patients |
| Sea Mar Community Health Centers | Family Medicine | Current |
Accepting new patients |
| Sea Mar Community Health Centers | Current |
Accepting new patients | |
| Trident Medical Services D/B/a Trident Senior Health Center | Past | Accepting new patients | |
| Sea-Mar Community Health Center | Family Medicine | Past | Accepting new patients |
Locations
4455 Cordata Pkwy
Bellingham, WA 98226
Phone (360) 671-3225
6884 Hannegan Rd
Everson, WA 98247
Phone (360) 354-0766
Interoperability endpoints
- jgrymaloski450455@direct.multicare.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | MD60051086 | WA | |
| Family Medicine Physician | 207Q00000X | MD60051086 | WA | Yes |
Addresses
Primary practice location
6884 Hannegan Rd
Everson, WA 98247-9637
Mailing address
PO Box 34703
Seattle, WA 98124-1703
Phone (206) 764-3335
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 058414200 | Medicaid | MN |
Other providers in Everson, WA
- Brian Alexander Gilmore
- Gordon Kelch DDS PLLC
- Ingrid T. Grant
- Nikki Gray
- Riley Joy Groves
- Joni Marie Hamilton
- Angela Lee Henderson
- Melissa Hildebrand
- Patti Hoelzle
- Madison B Holup
All providers in Everson, WA · Family Medicine Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.