Individual provider Active NPI

Jonathan R Grima, DO

  • Emergency Medicine Physician
  • Jackson, MI
National Provider Identifier
1922364496
Registry record updated Mar 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5101020595 Issued in MI
Practice address
205 N East Ave
Jackson, MI 49201-1753
Phone
(517) 788-4811
NPI assigned
Apr 9, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 5101020595 MI Primary

Addresses

Primary practice location

205 N East Ave
Jackson, MI 49201-1753

Mailing address

205 N East Ave
Jackson, MI 49201-1753
Phone (517) 788-4811

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20170221000696 FL Practitioner - Emergency Medicine 5092944884 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Emergency Medicine of Broward LLCGroup PAC ID 5991793002, 69 clinicians

Practice addresses (Care Compare)

201 E Sample Rd
Deerfield Beach, FL 33064-3502
Phone (954) 939-5000

Hospital & facility affiliations

  • Broward Health Coral Springs Hospital, Coral Springs, FL, CCN 100276
  • Broward Health North Hospital, Deerfield Beach, FL, CCN 100086
  • Broward Health Medical Center Hospital, Fort Lauderdale, FL, CCN 100039

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5101020595MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Emergency Medicine of Broward LLC Emergency Medicine CurrentSince Jan 1, 2017 Accepting new patients
Phoenix Emergency Medicine of Broward LLC Emergency Medicine CurrentSince Jan 1, 2017 Accepting new patients
Phoenix Emergency Medicine of Broward LLC Emergency Medicine Current Accepting new patients

Locations

201 E Sample Rd
Deerfield Beach, FL 33064
Phone (954) 786-6400

6401 N Federal Hwy
Ft Lauderdale, FL 33308
Phone (954) 776-8500

1600 S Andrews Ave
Ft Lauderdale, FL 33316
Phone (954) 355-4000

3000 Coral Hills Dr
Pompano Beach, FL 33065
Phone (954) 344-3000

3114 Croasdaile Dr
#200
Durham, NC 27705
Phone (877) 751-1157

Organizations & group practices 3

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1333929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459209600000",
    "number": "1922364496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-788-4811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-788-4811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMA",
        "first_name": "JONATHAN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-09",
        "last_updated": "2016-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101020595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.