Gordon Bradley Greaves, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA615 Issued in ID

Practice address

15821 Allendale Rd
Wilder, ID 83676-5864

Phone

(208) 278-2863

Fax

(208) 621-3128

NPI assigned

Jul 8, 2006

Last updated

Apr 14, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• G Brad Greaves Other name

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

Specialty

Physician Assistant

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Snake River Mental Health, PLLC

  • Psychiatry Physician
  • Wilder, ID
  • NPI 1497565832
  NPD Authorized official
• Psychiatric Services Behavioral Health Clinic Inc

  dba Psbhc

  • Community/Behavioral Health Agency
  • Twin Falls, ID
  • NPI 1013204957
  NPD (past)
• Psychiatric Services, PA

  • Psychiatry Physician
  • Twin Falls, ID
  • NPI 1528136793
  NPD (past)

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744588800000",
    "number": "1699708131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15821 ALLENDALE RD",
            "city": "WILDER",
            "state": "ID",
            "postal_code": "836765864",
            "telephone_number": "208-278-2863",
            "fax_number": "208-621-3128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15821 ALLENDALE RD",
            "city": "WILDER",
            "state": "ID",
            "postal_code": "836765864",
            "telephone_number": "208-278-2863",
            "fax_number": "208-621-3128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREAVES",
        "first_name": "GORDON",
        "middle_name": "BRADLEY",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2025-04-14",
        "certification_date": "2025-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "16369",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ID",
            "license": "PA615",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807537400",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "16369",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO BOARD OF MEDICINE",
            "identifier": "PA615",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "G",
            "last_name": "GREAVES",
            "middle_name": "BRAD",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sarah Badgley, L.M. ; C.P.M.
• Nicole Melissa Garrett
• Rebecca Lee Guy, MSN, APRN, NP-C
• Hti Physican Services of Utah,Inc
• Shaina Leeann Lonai
• Sharon Joy Monasmith, CNM
• Melinda Lou Mulkey

• Physician Assistant in Wilder, ID
• Providers in Wilder, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2025; 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.