NPIMap

Organization Active NPI

Gritman Medical Center Inc

  • 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
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
Organization subpart
Yes
Parent organization
GRITMAN MEDICAL CENTER INCAs reported in NPPES

Authorized official

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

Other NPIs on the same Medicare enrollment 8

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

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

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

National Provider Directory

National Provider Directory
Part of
Gritman Medical Center Inc

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

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

NPPES NPI Registry
  • GRITMAN NEUROSURGERY Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 9, 2023.

{
    "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.