Theresa Grimes, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F332400-1 Issued in NY

Practice address

75 N Country Rd
Port Jefferson, NY 11777-2119

Phone

(631) 476-2847

NPI assigned

Aug 14, 2006

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• John T Mather Memorial Hospital

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Port Jefferson, NY
  • NPI 1922486182
  Medicare reassignment NPD
• John T. Mather Memorial Hospital

  • Psychiatry Physician
  • Port Jefferson Station, NY
  • NPI 1376642371
  Medicare reassignment NPD
• John T Mather Memorial Hospital

  • Obesity Medicine (Internal Medicine) Physician
  • Port Jefferson, NY
  • NPI 1366816894
  NPD
• John T. Mather Memorial Hospital

  • Family Nurse Practitioner
  • Port Jefferson, NY
  • NPI 1417044066
  NPD
• John T. Mather Memorial Hospital

  • Critical Care Medicine (Internal Medicine) Physician
  • Port Jefferson, NY
  • NPI 1467249334
  NPD
• John T. Mather Memorial Hospital

  dba Breast Center

  • Diagnostic Radiology Physician
  • Port Jefferson, NY
  • NPI 1891816070
  NPD

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296777600000",
    "number": "1912910910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 MONITOR CT",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117271634",
            "telephone_number": "631-476-2734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772119",
            "telephone_number": "631-476-2847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMES",
        "first_name": "THERESA",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2011-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F332400-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01993700",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barry S Greenberg, PH.D.
• Julianna Greene
• Jack M Greenwood, MD
• Daisy Dilrose Grewal, MEDICAL STUDENT
• Mary Gridley, MS BCBA
• Shelly Stephens Groenendyk, MD
• Maritza Lastra Groth, MD
• Jenna Guardino, RN BSN FNP B.C
• Mary Elizabeth Guerrero, M.S, CCC-SLP
• Mark Joseph Gugliotti, PT,DPT,MS,BSC,OCS

• Family Nurse Practitioner in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2011; 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.