Active NPI
Dallin William Griffin, MD
- Dermatology Physician
- Marshfield, WI
National Provider Identifier
1871295543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 1871295543
- Practice address
- 1000 N Oak Ave
Marshfield, WI 54449 - Phone
- (715) 387-5311
- NPI assigned
- Mar 20, 2023
- Last updated
- Jul 9, 2024
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | ||
| Dermatology Physician | 207N00000X | 1871295543 | WI | Primary |
| Internal Medicine Physician | 207R00000X | 1871295543 | ID | |
| Internal Medicine Physician | 207R00000X | MRM-2227 | ID |
Addresses
Primary practice location
1000 N Oak Ave
Marshfield, WI 54449
Mailing address
500 W Fort St # 111R
Boise, ID 83702-4599
Phone (208) 422-1314
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230502000818 | ID | Order and Referring Only - Dermatology | 9931564671 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1871295543 | WI | MD | Dermatology Physician |
| 1871295543 | ID | MD | Internal Medicine Physician |
| MRM-2227 | ID | MD | Internal Medicine Physician |
Interoperability endpoints
- dgriffin2752874@direct.trinity-health.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720483200000",
"number": "1871295543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 W FORT ST # 111R",
"city": "BOISE",
"state": "ID",
"postal_code": "837024599",
"telephone_number": "208-422-1314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 N OAK AVE",
"city": "MARSHFIELD",
"state": "WI",
"postal_code": "54449",
"telephone_number": "715-387-5311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIFFIN",
"first_name": "DALLIN",
"middle_name": "WILLIAM",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-03-20",
"last_updated": "2024-07-09",
"certification_date": "2024-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "WI",
"license": "1871295543",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "ID",
"license": "1871295543",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "ID",
"license": "MRM-2227",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Marshfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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.