Individual provider Active NPI

Christian Wheelihan

  • Clinical Social Worker
  • Boise, ID
National Provider Identifier
1487084588
Registry record updated Nov 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LMSW30242 Issued in ID
Practice address
4792 S Tinker Ave
Boise, ID 83709-4968
Phone
(208) 859-1008
NPI assigned
Nov 26, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LMSW30242 ID Primary

Addresses

Primary practice location

4792 S Tinker Ave
Boise, ID 83709-4968

Mailing address

4477 W Emerald St
Boise, ID 83706-2000
Phone (208) 321-0160

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20190906002956 ID Practitioner - Clinical Social Worker 6507195112 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3350 W Americana Ter
Suite 320
Boise, ID 83706-2548
Phone (208) 918-4429

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LMSW30242IDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Peace and Purpose Therapy LLC Clinical CurrentSince Sep 24, 2023 Accepting new patients

Locations

3350 W Americana Ter
Ste 320
Boise, ID 83706
Phone (208) 608-3587

Interoperability endpoints

  • Direct secure messaging: christian.wheelihan.1@24259.direct.athenahealth.com

Organizations & group practices 1

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": "1385424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385424000000",
    "number": "1487084588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4477 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837062000",
            "telephone_number": "208-321-0160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4792 S TINKER AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837094968",
            "telephone_number": "208-859-1008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHEELIHAN",
        "first_name": "CHRISTIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-26",
        "last_updated": "2013-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LMSW30242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.