Active NPI
Lawrence Kay Gibbon, MD
- Family Medicine Physician
- Post Falls, ID
National Provider Identifier
1053465559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- M4193
- Practice address
- 185 W 4TH Avenue
Suite B
Post Falls, ID 83854-7298 - Phone
- (208) 773-1592
- Fax
- (208) 773-9764
- NPI assigned
- Jan 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M4193 | ID | Primary |
Addresses
Primary practice location
185 W 4TH Avenue
Suite B
Post Falls, ID 83854-7298
Mailing address
185 W 4TH Avenue
Suite B
Post Falls, ID 83854-7298
Phone (208) 773-1592
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080002699 | Other | ID | RAILROAD MDC |
| 41939 | Other | ID | BLUE CROSS |
| 0007628 | Medicaid | ID | |
| 000010006362 | Other | ID | REGENCE BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M4193 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frances Mahon Deaconess Hospital | Past | Accepting new patients | |
| Kootenai Health, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240790400000",
"number": "1053465559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "185 W 4TH AVENUE",
"address_2": "SUITE B",
"city": "POST FALLS",
"state": "ID",
"postal_code": "838547298",
"telephone_number": "208-773-1592",
"fax_number": "208-773-9764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "185 W 4TH AVENUE",
"address_2": "SUITE B",
"city": "POST FALLS",
"state": "ID",
"postal_code": "838547298",
"telephone_number": "208-773-1592",
"fax_number": "208-773-9764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBBON",
"first_name": "LAWRENCE",
"middle_name": "KAY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-22",
"last_updated": "2009-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "M4193",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MDC",
"identifier": "080002699",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "41939",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0007628",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "000010006362",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Post Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.