MR. JUSTIN ROGER GRIMES CRNA
NPI 1639592967
Nurse Anesthetist, Certified Registered in San Marcos, TX

NPI Status: Active since January 22, 2014

Contact Information

1305 WONDER WORLD DR
STE 105
SAN MARCOS, TX
ZIP 78666
Phone: (512) 353-8161
Fax: (512) 353-8255

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Areas of Expertise
Quality Reporting
Hospital Affiliations - Privileges
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Years of Experience 13
Nurse Anesthetist, Certified Registered
Accepts Insurance
Accepts Medicare Approved Payment
Medicare Quality Reporting

About JUSTIN GRIMES

This page provides the complete NPI Profile along with additional information for Justin Grimes, a provider established in San Marcos, Texas with a medical specialization in Nurse Anesthetist, Certified Registered and more than 13 years of experience. The healthcare provider is registered in the NPI registry with number 1639592967 assigned on January 2014. The practitioner's primary taxonomy code is 367500000X with license number 744531 (TX). The provider is registered as an individual and his NPI record was last updated 12 years ago.

NPI: 1639592967
Provider Name: MR. JUSTIN ROGER GRIMES CRNA
Gender: Male
Entity Type: Individual
Location Address: 1305 WONDER WORLD DR STE 105 SAN MARCOS, TX 78666
Location Phone: (512) 353-8161
Location Fax: (512) 353-8255
Mailing Address: 2804 W BIDDISON ST FORT WORTH, TX 76109
Mailing Phone: (806) 928-5053
Medical School Name: OTHER
Graduation Year: 2013
Is Sole Proprietor?: No
Enumeration Date: 01-22-2014
Last Update Date: 10-28-2014
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Nurse Anesthetist, Certified Registered
Taxonomy Code: 367500000X
Type: Physician Assistants & Advanced Practice Nursing Providers
License No.: 744531
License State: TX
Taxonomy Description: (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Baylor Scott and White Health Plan

BSW Diabetes Care Gold HMO 014 - HMO
BSW Elite Gold HMO 001 (CMS Standardized Plan with $0 Pediatric PCP copay) - HMO
BSW Elite Gold HMO 004 - HMO
BSW Elite Gold HMO 012 - HMO
BSW Prime Silver HMO 003 (CMS Standardized Plan with $0 Pediatric PCP copay) - HMO
BSW Prime Silver HMO 008 - HMO
BSW Prime Silver HMO 005 - HMO
BSW Savers Bronze HMO H S A 006 - HMO
BSW Savers Bronze HMO H S A 007 (CMS Standardized Plan with $0 Pediatric PCP copay) - HMO
BSW Savers Bronze HMO H S A 009 - HMO

Blue Cross and Blue Shield of Texas

Blue Advantage Bronze HMO? 204 - HMO
Blue Advantage Bronze HMO? 301 - HMO
Blue Advantage Bronze HMO? Standard - HMO
Blue Advantage Gold HMO? 206 - HMO
Blue Advantage Gold HMO? 603 - HMO
Blue Advantage Gold HMO? Standard - HMO
Blue Advantage Plus Bronze? 303 - POS
Blue Advantage Plus Bronze? 305 - POS
Blue Advantage Plus Bronze? Standard - POS
Blue Advantage Plus Gold? 203 - POS

CHRISTUS Health Plan

CHRISTUS Bronze (2 Free PCP Visits, $0 Preferred Generic Rx, $0 Virtual Urgent Care) - HMO
CHRISTUS Bronze + Dental & Vision (2 Free PCP Visits, $0 Preferred Generic Rx, $0 Virtual Urgent Care) - HMO
CHRISTUS Bronze Essential - HMO
CHRISTUS Bronze Essential (2 Free PCP Visits, $0 Preferred Generic Rx, $0 Virtual Urgent Care) - HMO
CHRISTUS Bronze Essential + Dental & Vision (2 Free PCP Visits, $0 Preferred Generic Rx, $0 Virtual Urgent Care) - HMO
CHRISTUS Bronze Essential Plus - HMO
CHRISTUS Catastrophic (3 Free PCP visits) - HMO
CHRISTUS Gold - HMO
CHRISTUS Gold + Dental & Vision + Fitness ($0 Deductible, $5 PCP, $0 Generic Rx, $0 Virtual Urgent Care) - HMO
CHRISTUS Gold + Fitness ($0 Deductible, $5 PCP, $0 Generic Rx, $0 Virtual Urgent Care) - HMO

Molina Healthcare

Molina Gold Core 1640 - HMO
Molina Gold Core 1640 Plus with Adult Dental and Vision - HMO
Molina Gold Core 1640 Plus with Adult Vision - HMO
Molina Gold Saver 750 - HMO
Molina Gold Saver 750 Plus with Adult Dental and Vision - HMO
Molina Gold Saver 750 Plus with Adult Vision - HMO
Molina Gold Standard - HMO
Molina Silver Core - HMO
Molina Silver Core Plus with Adult Dental and Vision - HMO
Molina Silver Core Plus with Adult Vision - HMO

Oscar Insurance Company

Bronze Classic 4700 - EPO
Bronze Classic Standard - EPO
Bronze Elite + PCP Saver Plus - EPO
Bronze Simple Breathe Easy with Enhanced COPD Benefits - EPO
Bronze Simple Chronic Care CKM - EPO
Bronze Simple Diabetes - EPO
Gold Classic - EPO
Gold Classic Guided Care - HMO
Gold Classic Standard - EPO
Gold Classic Standard Guided Care - HMO

Sendero Health Plans, Local Nonprofit

Sendero Health Austin512 Silver / $40 PCP / $75 Specialist / $15 Generic Drugs / $0 Deductible - HMO
Sendero Health Capital Silver / $40 PCP / $80 Specialist / $20 Generic Drugs - HMO
Sendero Health Hill Country Gold / $30 PCP / $60 Specialist / $15 Generic Drugs - HMO
Sendero Health Original Silver / $20 PCP + 2 $0 PCP Visits / $10 Generic Drugs - HMO
Sendero Health Preferred Bronze / $25 PCP / $75 Specialist / $22 Generic Drugs - HMO
Sendero Health Quality Care Bronze High Deductible / $50 PCP / $25 Generic Drugs / $100 Specialist - HMO
Sendero Health Real Gold / $350 Deductible - HMO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

Justin Grimes is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

PECOS PAC ID: 941433585
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.
PECOS Enrollment ID: I20140506000160
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.
Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Anesthesia for other procedure on esophagus, stomach, or upper small bowel using an endoscope
Anesthesia for other procedure on urinary system through urethra
Ultrasonic guidance for needle placement

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $31.6 for a new patient copayment and $17.13 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 78666 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

Average New Patient Price $126.4
Minimum New Patient Price $54.84
Maximum New Patient Price $166.88

Average New Patient Copayment $31.6
Minimum New Patient Copayment $13.71
Maximum New Patient Copayment $41.72

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

Average Established Patient Price $68.55
Minimum Established Patient Price $17.52
Maximum Established Patient Price $136.11

Average Established Patient Copayment $17.13
Minimum Established Patient Copayment $4.38
Maximum Established Patient Copayment $34.02

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure	Performance	Number of Patients
Implementation of improvements that contribute to more timely communication of test results	Yes	N/A
Timely communication of test results defined as timely identification of abnormal test results with timely follow-up.
Participation in an AHRQ-listed patient safety organization.	Yes	N/A
Participation in an AHRQ-listed patient safety organization.
Post-Anesthetic Transfer of Care Measure: Procedure Room to a Post Anesthesia Care Unit (PACU)	100%	165
Percentage of patients, regardless of age, who are under the care of an anesthesia practitioner and are admitted to a PACU or other non-ICU location in which a post-anesthetic formal transfer of care protocol or checklist which includes the key transfer of care elements is utilized
Use of QCDR data for ongoing practice assessment and improvements	Yes	N/A
Use of QCDR data, for ongoing practice assessment and improvements in patient safety.
Use of QCDR to promote standard practices, tools and processes in practice for improvement in care coordination	Yes	N/A
Participation in a Qualified Clinical Data Registry, demonstrating performance of activities that promote use of standard practices, tools and processes for quality improvement (e.g., documented preventative screening and vaccinations that can be shared across MIPS eligible clinician or groups).

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Justin Grimes is affiliated with the following medical facilities:

Hospital Name	Address	Phone	Hospital Type	Overall Rating
CHI ST LUKES HEALTH MEMORIAL LUFKIN	1201 WEST FRANK STREET LUFKIN, TX 75901	(936) 634-8111	Acute Care Hospitals
WOODLAND HEIGHTS MEDICAL CENTER	505 SOUTH JOHN REDDITT DRIVE LUFKIN, TX 75904	(936) 634-8311	Acute Care Hospitals

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1639592967, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 73. The final step is to find the difference between that total and the next multiple of ten (80 - 73 = 7).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 6

Pos 4

Unchanged

Pos 5

Doubled → 10 → 1 + 0

Pos 6

Unchanged

Pos 7

Doubled → 4

Pos 8

Unchanged

Pos 9

Doubled → 12 → 1 + 2

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 3 → 6 5 → 10 → 1 2 → 4 6 → 12 → 3

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 6 + 6 + 9 + 1 + 0 + 9 + 4 + 9 + 1 + 2 + 24 = 73

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 73 is 80. The difference is the calculated check digit.

80 - 73 = 7

This NPI is valid

The calculated check digit is 7, which matches the last digit of 1639592967.