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MRS. JENNY MARIE GRISSOM
NPI 1730424219
Counselor - Addiction (Substance Use Disorder) in Ukiah, CA

Active since December 10, 2012PECOS Enrolled
1120 S DORA ST, UKIAH, CA 95482(707) 472-2637 Get Directions Write a Review

NPPES record last updated: December 10, 2012. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Mrs. Jenny Marie Grissom NPPES

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

MRS. JENNY MARIE GRISSOM (NPI 1730424219) is an individual addiction (substance use disorder) provider in Ukiah, California, licensed in California (RI-G1004211925) and active in the NPI registry since December 2012. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1730424219
Entity TypeIndividualFemale
Primary Taxonomy101YA0400X
Provider Legal NameMRS. JENNY MARIE GRISSOM
Location Address1120 S DORA STUkiah, CA 95482-6340
Mailing Address1120 S Dora StUkiah, CA 95482-6340
Phone(707) 472-2637
Sole ProprietorNo
Enumeration DateDecember 10, 2012
✔ NPI 1730424219 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in CA · RI-G1004211925
1120 S DORA ST, Ukiah, CA 95482
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Jenny Marie Grissom is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignment

Medicare enrollment records show Jenny Grissom reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Mendocino Care Network
0.3 mi
Hospice and Palliative Medicine
1080 N STATE ST
Ukiah, CA 95482
  • Reassigned Medicare billing, California enrollment
  • 12 clinicians in this Medicare group
NPI 1083255095 (707) 380-5080

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

ROBIN THOMAS
Case Manager/Care Coordinator
1120 S DORA ST
UKIAH, CA 95482
Mendocino County (707) 671-3034
ROBERT THAYNE HAKE
Counselor (Addiction (Substance Use Disorder))
1120 S DORA ST
UKIAH, CA 95482
Mendocino County (707) 472-2627
MARIA LISA PULIDO
Community Health Worker
1120 S DORA ST
UKIAH, CA 95482
Mendocino County (707) 472-2717
MARGARITA GONZALEZ
Case Manager/Care Coordinator
1120 S DORA ST
UKIAH, CA 95482
Mendocino County (707) 472-2600
MIMI WHITTAKER
Case Manager/Care Coordinator
1120 S DORA ST
UKIAH, CA 95482
Mendocino County (707) 472-2367
MARIA MCCARTHY MA, MFT
Marriage & Family Therapist
1120 S DORA ST
UKIAH, CA 95482
Mendocino County (707) 472-2322
CONNIE ROSS
Counselor (Addiction (Substance Use Disorder))
1120 S DORA ST
UKIAH, CA 95482
Mendocino County (707) 472-2604
LILIA ARREDONDO
Case Manager/Care Coordinator
1120 S DORA ST
UKIAH, CA 95482
Mendocino County (707) 472-2718

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jenny Grissom's NPI number?

The NPI number for Jenny Grissom is 1730424219. It was assigned to this individual provider in the NPPES registry on December 10, 2012.

Where is Jenny Grissom located?

Jenny Grissom practices at 1120 S Dora St, Ukiah, CA 95482. The listed phone number is (707) 472-2637.

What is Jenny Grissom's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Is Jenny Grissom enrolled in Medicare?

Yes. Jenny Grissom is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jenny Grissom's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jenny Grissom reassigns Medicare benefits to Mendocino Care Network (Ukiah, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jenny Grissom's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jenny Grissom was last updated on December 10, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years 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.