Gritman Medical Center Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

GRITMAN MEDICAL CENTER INC

Doing business as

Troy Clinic

Practice address

412 S Main St
Troy, ID 83871-0415

Phone

(208) 835-5550

Fax

(208) 883-6580

NPI assigned

Apr 16, 2012

Last updated

Oct 9, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

GRITMAN MEDICAL CENTER INCAs reported in NPPES

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

Authorized official

Name

Mr. Patrick McConnell

Title

Cfo

Phone

(208) 883-2220

Specialties & licenses 2

Addresses

Other names 1

• TROY CLINIC Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

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

• Gritman Medical Center Inc

  • Critical Access Hospital
  • Moscow, ID
  • NPI 1619988144

  O20040402001021

  Same enrollment
• Gritman Medical Center Inc.

  dba Gritman Internal Medicine Clinic

  • Clinic/Center
  • Moscow, ID
  • NPI 1790182590

  O20040402001021

  Same enrollment

Part of

Gritman Home Health

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Gritman Medical Center Inc.

  dba Gritman Internal Medicine Clinic

  • Clinic/Center
  • Moscow, ID
  • NPI 1790182590

  Member Of

  NPD member

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Richard K Howe, MD

  • Family Medicine Physician
  • San Francisco, CA
  • NPI 1871566679
  NPD
• Guillermo Modad, M.D.

  • Internal Medicine Physician
  • Pullman, WA
  • NPI 1588982888
  NPD

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

{
    "created_epoch": "1334534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475971200000",
    "number": "1942567847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S MAIN ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838433056",
            "telephone_number": "208-882-4511",
            "fax_number": "208-883-6571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 S MAIN ST",
            "city": "TROY",
            "state": "ID",
            "postal_code": "838710415",
            "telephone_number": "208-835-5550",
            "fax_number": "208-883-6580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRITMAN MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRITMAN MEDICAL CENTER INC",
        "enumeration_date": "2012-04-16",
        "last_updated": "2016-10-09",
        "status": "A",
        "authorized_official_last_name": "MCCONNELL",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "208-883-2220",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TROY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• City of Troy
• Crystal Davis Counseling LLC
• Davis and Davis LLC
• Haylee Layne Dudley, M.S. CCC-SLP
• Gritman Medical Center Inc (Troy Clinic)
• Hailey Marae Haldeman, CCC-SLP
• Jennifer L Rouse
• Susan Katherine Struble, L.M.
• Troy School District 287
• Troy Volunteer Fire and Ambulance

• Family Medicine Physician in Troy, ID
• Providers in Troy, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2016; 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.