Raegan Griscom

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

LP-0010421 Issued in DE

Practice address

1601 Kirkwood Hwy FL 3
Wilmington, DE 19805-4917

Phone

(302) 994-5211

NPI assigned

May 31, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in DE

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

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

{
    "created_epoch": "1622419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622419200000",
    "number": "1932775004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 DILWORTH RD",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198051214",
            "telephone_number": "302-388-3933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 KIRKWOOD HWY FL 3",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198054917",
            "telephone_number": "302-994-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISCOM",
        "first_name": "RAEGAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-31",
        "last_updated": "2021-05-31",
        "certification_date": "2021-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "DE",
            "license": "LP-0010421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "raegan.griscom@va.gov",
            "affiliation": "N",
            "address_1": "1601 Kirkwood Hwy Fl 3",
            "city": "Wilmington",
            "state": "DE",
            "country_code": "US",
            "postal_code": "198054917",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Laurie Anne Griffith, LPC
• Melissa C Griffith, OTRL
• Jennifer W Grilli, DO
• Michelle Grimes
• Karen W. Gripp, MD
• Leslie E. Grissom, MD
• Marc David Grobman, D.O.
• Sidney M Grobman, D.O.
• Kelsey Groening, MS, RD, LDN
• Susan Gross, OTR/L

• Primary Care Nurse Practitioner in Wilmington, DE
• Providers in Wilmington, DE by specialty
• Primary Care Nurse Practitioner in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2021; 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.