Active NPI
Gregory David Gibson
- Counselor
- Easton, MD
National Provider Identifier
1386863330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 29520 Canvasback Dr
Easton, MD 21601-7124 - Phone
- (410) 822-5007
- Fax
- (410) 822-5569
- NPI assigned
- Apr 25, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | MD | Primary |
Addresses
Primary practice location
29520 Canvasback Dr
Easton, MD 21601-7124
Mailing address
2336 Goddard Parkway
Salisbury, MD 21801
Phone (410) 334-6961
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 609500303 | Medicaid | MD | |
| 609550001 | Medicaid | MD | |
| 609550004 | Medicaid | MD | |
| LM49EA | Other | MD | CAREFIRST BCBS GROUP |
| R968 | Other | CAREFIRST FEDERAL GROUP | |
| 517251 | Other | UHC MAMSI GROUP | |
| 609550002 | Medicaid | MD | |
| 609500300 | Medicaid | MD | |
| 259147000 | Other | MD | MAGELLAN GROUP |
| 609500301 | Medicaid | MD |
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern Shore Psychological Service, LLC | Past | Accepting new patients | |
| Eastern Shore Psychological Service | 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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Salisbury, MD
- NPI 1548348402
-
- Community/Behavioral Health Agency
- Princess Anne, MD
- NPI 1730252537
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424390400000",
"number": "1386863330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2336 GODDARD PARKWAY",
"city": "SALISBURY",
"state": "MD",
"postal_code": "21801",
"telephone_number": "410-334-6961",
"fax_number": "410-334-6362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29520 CANVASBACK DR",
"city": "EASTON",
"state": "MD",
"postal_code": "216017124",
"telephone_number": "410-822-5007",
"fax_number": "410-822-5569"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "GREGORY",
"middle_name": "DAVID",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-25",
"last_updated": "2015-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MD",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "609500303",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "609550001",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "609550004",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST BCBS GROUP",
"identifier": "LM49EA",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST FEDERAL GROUP",
"identifier": "R968",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC MAMSI GROUP",
"identifier": "517251",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "609550002",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "609500300",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN GROUP",
"identifier": "259147000",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "609500301",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Easton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.