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KENNETH E. GRULLON MD
NPI 1801974977
Obstetrics & Gynecology in Antioch, CA

Active since November 02, 2006PECOS Enrolled
3400 DELTA FAIR BLVD, ANTIOCH, CA 94509(925) 779-5000 Get Directions Write a Review

NPPES record last updated: December 17, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Kenneth E. Grullon Md NPPES

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

KENNETH E. GRULLON MD (NPI 1801974977) is an individual obstetrics & gynecology provider in Antioch, California, licensed in California (G76376) and active in the NPI registry since November 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1801974977
Entity TypeIndividualMale
Primary Taxonomy207V00000X
Provider Legal NameKENNETH E. GRULLONCredential: MD
Location Address3400 DELTA FAIR BLVDAntioch, CA 94509-4004
Mailing Address1800 Harrison St Fl 7Oakland, CA 94612-3466 · (510) 625-6262
Phone(925) 779-5000
Sole ProprietorNo
Enumeration DateNovember 2, 2006
Last NPPES UpdateDecember 17, 2021
✔ NPI 1801974977 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
License✔ Licensed in CA · G76376
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
3400 DELTA FAIR BLVD, Antioch, CA 94509
Open in Google Maps ↗

Other Identifiers 1

Medicaid00G763760CA

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kenneth E. Grullon Md 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 Kenneth Grullon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Permanente Medical Group Inc
24 mi
Internal Medicine
975 SERENO DRIVE
Vallejo, CA 94589
  • Reassigned Medicare billing, California enrollment
  • 20,078 clinicians in this Medicare group
NPI 1336222397 (707) 651-1000

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 94509 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
$153.83 typical visit price
range $69.00 – $202.35
Typical copayment $38.45 (range $17.25 – $50.58)
Most-billed visit code 99204
Established Patient
$84.91 typical visit price
range $23.44 – $166.46
Typical copayment $21.22 (range $5.86 – $41.61)
Most-billed visit code 99213
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.

MATTHEW ROBERT WHITE PT
Physical Therapist
3400 DELTA FAIR BLVD
ANTIOCH, CA 94509
Contra Costa County (925) 779-5442
ROSETTA C. NEWHALL MD
Pediatrics
3400 DELTA FAIR BLVD
ANTIOCH, CA 94509
Contra Costa County (925) 779-5000
DR. SANAZ STACY ABOUTALEBI-SIMON O.D.
Optometrist (Corneal and Contact Management)
3400 DELTA FAIR BLVD, THE PERMANENTE MEDICAL GROUP, INC.
ANTIOCH, CA 94509
Contra Costa County (925) 779-5223
RAJ V. DASARI MD
Emergency Medicine
3400 DELTA FAIR BLVD
ANTIOCH, CA 94509
Contra Costa County (925) 779-5000
DR. ATHENA PANZAR PSY.D.
Counselor (Mental Health)
3400 DELTA FAIR BLVD
ANTIOCH, CA 94509
Contra Costa County (925) 779-5090
AL G. SUMAQUIAL MD
Internal Medicine
3400 DELTA FAIR BLVD
ANTIOCH, CA 94509
Contra Costa County (925) 779-5000
BERNABE FLORO URBANO JR. MD
Pediatrics
3400 DELTA FAIR BLVD
ANTIOCH, CA 94509
Contra Costa County (925) 779-5000
BOREY SOM
Pharmacist
3400 DELTA FAIR BLVD
ANTIOCH, CA 94509
Contra Costa County (925) 779-5247

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 Kenneth Grullon's NPI number?

The NPI number for Kenneth Grullon is 1801974977. It was assigned to this individual provider in the NPPES registry on November 2, 2006.

Where is Kenneth Grullon located?

Kenneth Grullon practices at 3400 Delta Fair Blvd, Antioch, CA 94509. The listed phone number is (925) 779-5000.

What is Kenneth Grullon's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Kenneth Grullon enrolled in Medicare?

Yes. Kenneth Grullon is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kenneth Grullon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Grullon reassigns Medicare benefits to Permanente Medical Group Inc (Vallejo, 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 Kenneth Grullon'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 Kenneth Grullon was last updated on December 17, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.