NPIMap

Organization Active NPI

Gritman Medical Center Inc

Doing business as Gritman Neurosurgery

  • Neurological Surgery Physician
  • Moscow, ID
National Provider Identifier
1487428447
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
GRITMAN MEDICAL CENTER INC
Doing business as
Gritman Neurosurgery
Practice address
803 S Main St Ste 320
Moscow, ID 83843-2695
Phone
(208) 883-1008
Fax
(208) 883-4563
NPI assigned
Nov 9, 2023
Last updated
Nov 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
GRITMAN MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

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

Authorized official

Name
Danielle Lynas
Title
Gritman Cfo
Phone
(208) 883-2220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X Primary

Addresses

Primary practice location

803 S Main St Ste 320
Moscow, ID 83843-2695

Mailing address

PO Box 8007
Moscow, ID 83843-0507
Phone (208) 883-6359

Other practice location 1

700 S Main St
Moscow, ID 83843-3056
Phone (208) 882-4511

Other names 1

  • GRITMAN NEUROSURGERY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161130002249 ID Part B Supplier - Clinic/Group Practice 4981984390 Receives reassigned benefits from 29 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Moscow, ID

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Gritman Medical Center Inc

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1699488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1487428447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8007",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838430507",
            "telephone_number": "208-883-6359",
            "fax_number": "208-892-3714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 S MAIN ST STE 320",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838432695",
            "telephone_number": "208-883-1008",
            "fax_number": "208-883-4563"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 S Main St",
            "address_purpose": "LOCATION",
            "city": "Moscow",
            "state": "ID",
            "postal_code": "838433056",
            "country_code": "US",
            "telephone_number": "208-882-4511",
            "fax_number": "208-883-6580",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRITMAN MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRITMAN MEDICAL CENTER INC",
        "enumeration_date": "2023-11-09",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "LYNAS",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "GRITMAN CFO",
        "authorized_official_telephone_number": "208-883-2220"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRITMAN NEUROSURGERY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moscow, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.