NPIMap

Individual provider Active NPI

Gordon G Croft, D.M.D.

  • General Practice Dentistry
  • Boise, ID
National Provider Identifier
1417126244
Registry record updated Apr 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D1518 Issued in ID
Practice address
8300 Northview St
Boise, ID 83704-7132
Phone
(208) 377-8078
Fax
(208) 377-3689
NPI assigned
Feb 26, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D1518 ID Primary

Addresses

Primary practice location

8300 Northview St
Boise, ID 83704-7132

Mailing address

PO Box 9
Nampa, ID 83653-0009
Phone (208) 467-4431

Other identifiers 3

IdentifierTypeStateIssuer
6C396OtherIDBLUE CROSS
000789200MedicaidID
462879OtherIDUNITED CONCORDIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180501002282 ID Order and Referring Only - DentistPractitioner - Dentist 6608130547

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D1518IDMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Dental Center General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1203984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524441600000",
    "number": "1417126244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836530009",
            "telephone_number": "208-467-4431",
            "fax_number": "208-467-3391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8300 NORTHVIEW ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837047132",
            "telephone_number": "208-377-8078",
            "fax_number": "208-377-3689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROFT",
        "first_name": "GORDON",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-26",
        "last_updated": "2018-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D1518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "6C396",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000789200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "462879",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.