Active NPI
Mark W Grimm, M.D.
- Otolaryngology Physician
- Fenton, MO
National Provider Identifier
1942271689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 2001018662
- Practice address
- 1011 Bowles Ave
Suite 405
Fenton, MO 63026-2395 - Phone
- (314) 965-9184
- NPI assigned
- Jan 31, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 2001018662 | MO | Primary |
Addresses
Primary practice location
1011 Bowles Ave
Suite 405
Fenton, MO 63026-2395
Mailing address
PO Box 790379
Saint Louis, MO 63179-0379
Phone (314) 965-9184
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Louis University | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305763200000",
"number": "1942271689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 790379",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631790379",
"telephone_number": "314-965-9184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 BOWLES AVE",
"address_2": "SUITE 405",
"city": "FENTON",
"state": "MO",
"postal_code": "630262395",
"telephone_number": "314-965-9184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMM",
"first_name": "MARK",
"middle_name": "W",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-31",
"last_updated": "2011-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "MO",
"license": "2001018662",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.