Vladislav G Groysman, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

OL61443656 Issued in WA

Practice address

1717 S J St
Tacoma, WA 98405-4933

Phone

(253) 426-4101

NPI assigned

Jun 19, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1962187807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 TACOMA AVE S APT 221",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984021823",
            "telephone_number": "646-322-0494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S J ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054933",
            "telephone_number": "253-426-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROYSMAN",
        "first_name": "VLADISLAV",
        "middle_name": "G",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-19",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "OL61443656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas Alvin Grow, MD. PH.D.
• Erin Martha Grow
• Growing Community Services
• Growth and Healing Psychological Services, Inc
• Growth. Occupational Therapy and Wellness PLLC
• Leo Gruba
• Serena Gruba
• Shaconnie Grubb, LCSW, MSW, MPH
• Calvin Grubbs III, MD, FAAFP
• Lindsay Kay Grubish, D.O.

• Internal Medicine Physician in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; 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.