Jose Gerardo Pacheco, LICSW, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

5761478 Issued in ID

Practice address

4750 N Five Mile Rd
Boise, ID 83713-2715

Phone

(208) 996-0931

NPI assigned

Oct 9, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA, ID2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lewis County Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Chehalis, WA
  • NPI 1134164692
  Medicare reassignment NPD
• Valley Behavioral Health Incorporated

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • West Valley City, UT
  • NPI 1932166980

  Clinical, ID

  Medicare reassignment NPD
• Lewis County Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Olympia, WA
  • NPI 1124739974
  NPD
• Lewis County Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Centralia, WA
  • NPI 1811669658
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1073088779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4750 N FIVE MILE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837132715",
            "telephone_number": "208-614-9448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4750 N FIVE MILE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837132715",
            "telephone_number": "208-996-0931"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2690 NE Kresky Ave",
            "address_purpose": "LOCATION",
            "city": "Chehalis",
            "state": "WA",
            "postal_code": "985322412",
            "country_code": "US",
            "telephone_number": "360-330-9595 x2141",
            "fax_number": "360-330-7865",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "273 Sussex Ave E",
            "address_purpose": "LOCATION",
            "city": "Tenino",
            "state": "WA",
            "postal_code": "985899359",
            "country_code": "US",
            "telephone_number": "360-264-5665",
            "fax_number": "360-330-7865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PACHECO",
        "first_name": "JOSE",
        "middle_name": "GERARDO",
        "credential": "LICSW, MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-09",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "5761478",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WA",
            "license": "LW61310284",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenyon L Oyler, DDS
• Maryann Ozier, P.A.
• Susan M Ozimkiewicz, MA, NCC, LCPC
• Gary R. Pabalis, O.D.
• Ashlynn Irene Pabawena
• Martha Marie Pacheco, M.D.
• Pacific Cataract and Laser Institute Inc PC
• Pacific Healthline PLLC
• Pacific Hospice Inc
• Pacific Medical, Inc.

• Clinical Social Worker in Boise, ID
• Providers in Boise, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.