Dale Forrest Grooms, ATC

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

96000739 Issued in IL

Practice address

385 Winnetka Ave
Winnetka, IL 60093-4238

Phone

(847) 501-6445

Fax

(847) 446-8247

NPI assigned

Nov 3, 2006

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962581660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 WINNETKA AVE",
            "city": "WINNETKA",
            "state": "IL",
            "postal_code": "600934238",
            "telephone_number": "847-501-6445",
            "fax_number": "847-446-8247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "385 WINNETKA AVE",
            "city": "WINNETKA",
            "state": "IL",
            "postal_code": "600934238",
            "telephone_number": "847-501-6445",
            "fax_number": "847-446-8247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROOMS",
        "first_name": "DALE",
        "middle_name": "FORREST",
        "name_prefix": "Mr.",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "96000739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Goodman, MD
• Ronna Gordon
• Janet Beth Goss, M.A., L.P.C.
• Walter R Grobelny Jr., M.D.
• Grohmann Psychological Services, PLLC
• Brooke V Grossblatt
• Lauren Gumbiner, MSW, LCSW
• Andres Gutierrez, MD
• Michael John Harms, OD
• Kelsey Hasmonek

• All providers in Winnetka, IL
• Student in an Organized Health Care Education/Training Program in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.