Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

KRISTIE MICHELLE GRIMES-MALLARD RN
NPI 1730797077
Nurse Practitioner - Women's Health in Roxbury, MA

Q: What is Kristie Grimes-mallard's NPI number?

The NPI number for Kristie Grimes-mallard is 1730797077. It was assigned to this individual provider in the NPPES registry on July 22, 2020.

Q: What is Kristie Grimes-mallard's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Women's Health, with taxonomy code 363LW0102X.

Active since July 22, 2020PECOS EnrolledAccepts Medicare Assignment

45 DIMOCK ST, ROXBURY, MA 02119(617) 442-8800(617) 541-8334 Get Directions Write a Review

NPPES record last updated: September 29, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 29, 2026, Nov 16, 2020, Jul 28, 2020 and 1 more (4 updates tracked since 2020).

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About Kristie Michelle Grimes-mallard Rn NPPES

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

KRISTIE MICHELLE GRIMES-MALLARD RN (NPI 1730797077) is an individual women's health provider in Roxbury, Massachusetts, licensed in Massachusetts (RN2335640) and active in the NPI registry since July 2020. She is enrolled in Medicare PECOS, maintains a secondary practice location in Brighton, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1730797077

Entity TypeIndividualFemale

Primary Taxonomy363LW0102X

Provider Legal NameKRISTIE MICHELLE GRIMES-MALLARDCredential: RN

Location Address45 DIMOCK STRoxbury, MA 02119-1208

Mailing Address960 Massachusetts Avenue, Fl 2Boston, MA 02118-2690

Phone(617) 442-8800

Fax(617) 541-8334

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateJuly 22, 2020

Last NPPES UpdateSeptember 29, 20264 updates tracked since enumeration

NPPES CertifiedSeptember 29, 2026

✔ NPI 1730797077 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Women's HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LW0102X

License✔ Licensed in MA · RN2335640

45 DIMOCK ST, Roxbury, MA 02119

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Secondary Practice Location 1

Location 1736 Cambridge St, 5th FL, Maternal Child Health BldgBrighton, MA 02135-2907 · Phone (617) 562-7007

Other Identifiers 1

Medicaid110164451AMA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Taro Health.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kristie Michelle Grimes-mallard Rn 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 ID6709205461

PECOS Enrollment IDI20200929002571

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 Kristie Grimes-mallard reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Dimock Community Health Center, Inc

Same address

Federally Qualified Health Center (FQHC)

45 DIMOCK ST
Roxbury, MA 02119

Reassigned Medicare billing, Massachusetts enrollment
50 clinicians in this Medicare group

NPI 1588719488 (617) 442-8800

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 02119 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

$97.64 typical visit price

range $63.72 – $189.86

Typical copayment $24.41 (range $15.93 – $47.46)

Most-billed visit code 99203

Established Patient

$111.18 typical visit price

range $21.07 – $155.29

Typical copayment $27.79 (range $5.26 – $38.82)

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.

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