Individual provider Active NPI

Melissanne Ghiselli, ASW

  • Clinical Social Worker
  • Longmont, CO
National Provider Identifier
1225438476
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW.09926021 Issued in CO
Practice address
1750 E Ken Pratt Blvd
Longmont, CO 80504-5311
Phone
(720) 718-7000
Fax
(720) 718-0900
NPI assigned
Aug 25, 2014
Last updated
Feb 12, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X ASW27574 CA
Clinical Social Worker 1041C0700X CSW.09926021 CO Primary

Addresses

Primary practice location

1750 E Ken Pratt Blvd
Longmont, CO 80504-5311

Mailing address

1750 E Ken Pratt Blvd
Longmont, CO 80504-5311
Phone (720) 718-7000

Other practice location 1

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 853-2240

Other names 1

  • Missy Anastasia Gallo Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20200302000547 CO Practitioner - Clinical Social Worker 7113148610 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1750 E Ken Pratt Blvd
Uchealth
Longmont, CO 80504-5311
Phone (970) 237-7848

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW27574CAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Current Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jan 20, 2020 Accepting new patients

Locations

11820 Destination Dr
Broomfield, CO 80021
Phone (303) 460-6000

1750 E Ken Pratt Blvd
Longmont, CO 80504
Phone (720) 718-7000

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1408924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581465600000",
    "number": "1225438476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 E KEN PRATT BLVD",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805045311",
            "telephone_number": "720-718-7000",
            "fax_number": "720-718-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 E KEN PRATT BLVD",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805045311",
            "telephone_number": "720-718-7000",
            "fax_number": "720-718-0900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "795 El Camino Real",
            "address_purpose": "LOCATION",
            "city": "Palo Alto",
            "state": "CA",
            "postal_code": "94301",
            "country_code": "US",
            "telephone_number": "650-853-2240",
            "fax_number": "408-523-3779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GHISELLI",
        "first_name": "MELISSANNE",
        "credential": "ASW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-25",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "ASW27574",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09926021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MISSY",
            "last_name": "GALLO",
            "middle_name": "ANASTASIA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Longmont, CO

Sources for this page

Verify at the official NPI Registry.