Individual provider Active NPI

Brianna Ashley Cracolice, NP-C

  • Primary Care Nurse Practitioner
  • Nampa, ID
National Provider Identifier
1639640402
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
NP-53580 Issued in ID
Practice address
1510 12TH Ave Rd
Nampa, ID 83686-6008
Phone
(208) 302-6800
Fax
(208) 302-6855
NPI assigned
Dec 5, 2018
Last updated
Feb 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 53580 ID
Primary Care Nurse Practitioner 363LP2300X NP-53580 ID Primary

Addresses

Primary practice location

1510 12TH Ave Rd
Nampa, ID 83686-6008

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 302-9342

Other practice location 1

215 E Hawaii Ave
Nampa, ID 83686-6011
Phone (208) 468-5910

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address brianna.cracolice@sal.eclinicaldirectplus.com Direct

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190227002443 ID Practitioner - Nurse Practitioner 3173862661 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1510 12TH Ave Rd
Suite 200
Nampa, ID 83686-6008
Phone (208) 302-6899

1512 12TH Ave Rd
Suite 100
Nampa, ID 83686-6008
Phone (208) 467-1171

3025 W Cherry LN
Meridian, ID 83642-8531

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
53580IDMDFamily Nurse Practitioner
NP-53580IDMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Apr 1, 2024 Accepting new patients
Southern Idaho Health Partners LLC CurrentSince Oct 28, 2019 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Apr 1, 2024 Accepting new patients

Locations

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

875 S Vanguard Way
Meridian, ID 83642
Phone (208) 343-6458

1510 12th Ave Rd
Ste 200
Nampa, ID 83686
Phone (208) 302-0600

215 E Hawaii Ave
Nampa, ID 83686
Phone (208) 463-3234

9850 W St Lukes Dr
Ste 129
Nampa, ID 83687
Phone (208) 205-7600

Interoperability endpoints

  • Direct secure messaging: bcracolice3234962@direct.trinity-health.org

Organizations & group practices 4

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 6

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": "1543968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708992000000",
    "number": "1639640402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-302-9342",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866008",
            "telephone_number": "208-302-6800",
            "fax_number": "208-302-6855"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 E HAWAII AVE",
            "address_purpose": "LOCATION",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866011",
            "country_code": "US",
            "telephone_number": "208-468-5910",
            "fax_number": "208-463-3353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRACOLICE",
        "first_name": "BRIANNA",
        "middle_name": "ASHLEY",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-05",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "53580",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "ID",
            "license": "NP-53580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "brianna.cracolice@sal.eclinicaldirectplus.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "875 S Vanguard Way",
            "city": "Meridian",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836427552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

Verify at the official NPI Registry.