Active NPI
Breanna Gross, LMSW
- Social Worker
- Boise, ID
National Provider Identifier
1417634015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LMSW-45283
- Practice address
- 300 S 23Rd St
Boise, ID 83702-9100 - Phone
- (208) 344-3512
- Fax
- (208) 466-5359
- NPI assigned
- Jul 5, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | LMSW-45283 | ID | Primary |
Addresses
Primary practice location
300 S 23Rd St
Boise, ID 83702-9100
Mailing address
PO Box 9
Nampa, ID 83653-0009
Phone (208) 461-7149
Other practice location 1
24424 W McNichols Rd
Detroit, MI 48219-3653
Phone (313) 531-2500
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMSW-45283 | ID | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health Clinics, Inc. | Social Worker | Past | Accepting new patients |
| Community Health Clinics, Inc. | Social Worker | 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.
-
- Federally Qualified Health Center (FQHC)
- Caldwell, ID
- NPI 1043230501
Social Worker
-
- Federally Qualified Health Center (FQHC)
- Boise, ID
- NPI 1588678361
Social Worker
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724284800000",
"number": "1417634015",
"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": "208-461-7149",
"fax_number": "208-467-3391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 S 23RD ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837029100",
"telephone_number": "208-344-3512",
"fax_number": "208-466-5359"
}
],
"practiceLocations": [
{
"address_1": "24424 W McNichols Rd",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "482193653",
"country_code": "US",
"telephone_number": "313-531-2500",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GROSS",
"first_name": "BREANNA",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-05",
"last_updated": "2024-08-22",
"certification_date": "2024-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ID",
"license": "LMSW-45283",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.