Gregory Dickerson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-42076 Issued in ID

Practice address

4477 W Emerald St
Suite C100
Boise, ID 83706-2000

Phone

(208) 321-0160

Fax

(208) 321-0221

NPI assigned

Mar 3, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Benewah Medical CenterGroup PAC ID 6709878622, 27 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: gregory.dickerson.1@24259.direct.athenahealth.com

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.

• Benewah Medical Center

  dba Marimn Health

  • Federally Qualified Health Center (FQHC)
  • Plummer, ID
  • NPI 1336135136
  Medicare reassignment Care Compare group
• Behavioral Health Solutions of Idaho

  • Psychiatry Physician
  • Boise, ID
  • NPI 1164286092
  NPD (past)

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

{
    "created_epoch": "1393804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649894400000",
    "number": "1568887339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4477 W EMERALD ST",
            "address_2": "SUITE C100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837062000",
            "telephone_number": "208-321-0160",
            "fax_number": "208-321-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4477 W EMERALD ST",
            "address_2": "SUITE C100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837062000",
            "telephone_number": "208-321-0160",
            "fax_number": "208-321-0221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "GREGORY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-03",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-42076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Savannah Diaz, OTR/L
• Colleen Anne Dibble, MS, RD
• Emme Lee Dibble
• Pamela Dae Dick, MS, RD, CDCES
• Michael Dean Dickens, R.PH.
• Kimberly A Dickey, OT
• Kyla Maria Dickey, PHARMD.
• Daniel Jackson Dickman, D.O.
• Michael A Dickson
• Sue Soroor Didehban

• Clinical Social Worker in Boise, ID
• Providers in Boise, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.