Active NPI
Mary Elizabeth Grist, M.D.
- Pediatrics Physician
- Maumee, OH
National Provider Identifier
1912175316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 35.090606
- Practice address
- 1574 Henthorne Dr
Suite C
Maumee, OH 43537-1397 - Phone
- (419) 794-1407
- Fax
- (419) 794-1171
- NPI assigned
- Feb 19, 2008
- Last updated
- Feb 24, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 35.090606 | OH | Primary |
Addresses
Primary practice location
1574 Henthorne Dr
Suite C
Maumee, OH 43537-1397
Mailing address
1574 Henthorne Dr
Suite C
Maumee, OH 43537-1397
Phone (419) 794-1407
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2836319 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.090606 | OH | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wee Care Pediatrics, Inc. | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
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- Toledo, OH
- NPI 1669620639
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361664000000",
"number": "1912175316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1574 HENTHORNE DR",
"address_2": "SUITE C",
"city": "MAUMEE",
"state": "OH",
"postal_code": "435371397",
"telephone_number": "419-794-1407",
"fax_number": "419-794-1171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1574 HENTHORNE DR",
"address_2": "SUITE C",
"city": "MAUMEE",
"state": "OH",
"postal_code": "435371397",
"telephone_number": "419-794-1407",
"fax_number": "419-794-1171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIST",
"first_name": "MARY",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-19",
"last_updated": "2013-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "35.090606",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2836319",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maumee, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.