Active NPI
David Gibson, LICSW
- Clinical Social Worker
- Saint Paul, MN
National Provider Identifier
1134133374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 11191
- Practice address
- 821 Raymond Ave Ste 200
Saint Paul, MN 55114-1509 - Phone
- (651) 216-8899
- NPI assigned
- Jul 27, 2006
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 11191 | MN | Primary |
Addresses
Primary practice location
821 Raymond Ave Ste 200
Saint Paul, MN 55114-1509
Mailing address
1945 Stanford Ave
Saint Paul, MN 55105-1655
Phone (651) 216-8899
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 62-51344 | Other | MN | UBH |
| 1025840 | Other | MN | P1 |
| 123775 | Other | MN | UC |
| 12D53GI | Other | MN | BCBS |
| 46411 | Other | MN | HP |
| 475526000 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11191 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233014400000",
"number": "1134133374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1945 STANFORD AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551051655",
"telephone_number": "651-216-8899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "821 RAYMOND AVE STE 200",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551141509",
"telephone_number": "651-216-8899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "DAVID",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2009-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "11191",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH",
"identifier": "62-51344",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "P1",
"identifier": "1025840",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UC",
"identifier": "123775",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "12D53GI",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HP",
"identifier": "46411",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "475526000",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2009; 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.