The Gordian Mind

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

THE GORDIAN MIND

Practice address

296 W. Sunset Ave
Ste 15
Coeur D Alene, ID 83815-8366

Phone

(208) 666-0357

Fax

(208) 666-0468

NPI assigned

Jan 3, 2023

Organization subpart

No

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

Authorized official

Name

Jill Breitbach, PSYDNPI 1487626529

Title

Owner

Phone

(208) 666-0357

Specialties & licenses 1

Addresses

Other names 1

• Jill Breitbach, Psychologist Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jill Efta Breitbach, PSY D

  • Clinical Neuropsychologist
  • Coeur D Alene, ID
  • NPI 1487626529
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1672704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691366400000",
    "number": "1356054423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "296 W. SUNSET AVE",
            "address_2": "STE 15",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158366",
            "telephone_number": "208-666-0357",
            "fax_number": "208-666-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "296 W. SUNSET AVE",
            "address_2": "STE 15",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158366",
            "telephone_number": "208-666-0357",
            "fax_number": "208-666-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE GORDIAN MIND",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-03",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A",
        "authorized_official_last_name": "BREITBACH",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-666-0357",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jill Breitbach, Psychologist",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jill Breitbach, Psychologist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.