NPIMap

Individual provider Active NPI

Preetha S Rosen, MD

  • Sleep Medicine (Psychiatry & Neurology) Physician
  • Moscow, ID
National Provider Identifier
1487886099
Registry record updated Aug 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084S0012X
License
M-16797 Issued in ID
Practice address
700 S Main St
Moscow, ID 83843-3046
Phone
(208) 883-6236
Fax
(986) 600-4565
NPI assigned
Aug 14, 2009
Last updated
Aug 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X M-16797 ID Primary

Addresses

Primary practice location

700 S Main St
Moscow, ID 83843-3046

Mailing address

PO Box 8007
Moscow, ID 83843-0507
Phone (208) 882-4511

Other practice location 1

623 S Main St Ste 1
Moscow, ID 83843-3042
Phone (208) 882-2011

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
I20220907000424 ID Practitioner - Sleep Medicine 9638340813 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sleep Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gritman Medical Center IncGroup PAC ID 0941545784, 27 clinicians

Practice addresses (Care Compare)

623 S Main St
Suite 1
Moscow, ID 83843-2983
Phone (208) 882-2011

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St Joseph Hospital LLC CurrentSince Mar 17, 2025 Accepting new patients
Gritman Medical Center Inc Current Accepting new patients
Gritman Medical Center Inc CurrentSince Jun 15, 2023 Accepting new patients
Gritman Medical Center, Inc. CurrentSince Aug 15, 2022 Accepting new patients
Gritman Medical Center Inc CurrentSince Jun 15, 2023 Accepting new patients
Gritman Medical Center, Inc. CurrentSince Aug 15, 2022 Accepting new patients
Gritman Medical Center Inc CurrentSince Aug 15, 2022 Accepting new patients
Gritman Medical Center Inc. CurrentSince Aug 15, 2022 Accepting new patients
Gritman Medical Center Inc Sleep Medicine Past Accepting new patients

Locations

821 21st Ave
Lewiston, ID 83501
Phone (208) 799-3422

623 S Main St
Ste 1
Moscow, ID 83843
Phone (208) 882-2011

700 S Main St
Moscow, ID 83843
Phone (208) 746-7555

700 S Main St
Fl 3
Moscow, ID 83843

719 S Main St
Moscow, ID 83843
Phone (208) 848-8300

Interoperability endpoints

  • Direct secure messaging: prosen689746@direct.ochin.org

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1250208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1487886099",
    "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": "208-882-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S MAIN ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838433046",
            "telephone_number": "208-883-6236",
            "fax_number": "986-600-4565"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "623 S Main St Ste 1",
            "address_purpose": "LOCATION",
            "city": "Moscow",
            "state": "ID",
            "postal_code": "838433042",
            "country_code": "US",
            "telephone_number": "208-882-2011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSEN",
        "first_name": "PREETHA",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-14",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "ID",
            "license": "M-16797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moscow, ID

Sources for this page

Verify at the official NPI Registry.