SIMONIQUE JESSIE-ALLEAN GRISSOM
NPI 1710623012
Nurse Practitioner - Family in Denver, CO

Q: What is Simonique Grissom's NPI number?

The NPI number for Simonique Grissom is 1710623012. It was assigned to this individual provider in the NPPES registry on May 10, 2022.

Q: What is Simonique Grissom's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Simonique Grissom was last updated on December 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 10, 2022PECOS EnrolledAccepts Medicare Assignment

777 BANNOCK ST, DENVER, CO 80204(303) 436-4949(303) 602-4550 Get Directions Write a Review

NPPES record last updated: December 19, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 19, 2024, Oct 13, 2022, May 10, 2022 (3 updates tracked since 2022).

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About Simonique Jessie-allean Grissom NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SIMONIQUE JESSIE-ALLEAN GRISSOM (NPI 1710623012) is an individual family provider in Denver, Colorado, licensed in Colorado (APN.0997794-NP) and active in the NPI registry since May 2022. She is enrolled in Medicare PECOS, maintains a secondary practice location in Colorado Springs, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1710623012

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameSIMONIQUE JESSIE-ALLEAN GRISSOM

Location Address777 BANNOCK STDenver, CO 80204-4597

Mailing Address777 Bannock StDenver, CO 80204-4597 · (303) 436-4949 · Fax (303) 602-4550

Phone(303) 436-4949

Fax(303) 602-4550

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateMay 10, 2022

Last NPPES UpdateDecember 19, 20243 updates tracked since enumeration

NPPES CertifiedDecember 19, 2024

✔ NPI 1710623012 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in CO · APN.0997794-NP

777 BANNOCK ST, Denver, CO 80204

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Secondary Practice Location 1

Location 1225 S Union BlvdColorado Springs, CO 80910-3184 · Phone (719) 632-5700

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Simonique Jessie-allean Grissom is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7113393513

PECOS Enrollment IDI20260501003078

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 80204 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$89.43 typical visit price

range $58.06 – $174.82

Typical copayment $22.35 (range $14.51 – $43.70)

Most-billed visit code 99203

Established Patient

$102.03 typical visit price

range $18.88 – $142.79

Typical copayment $25.50 (range $4.72 – $35.69)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. KATHERINE JEANNE CARLEY RN, MSN, CS

Clinical Nurse Specialist (Psychiatric/Mental Health)