Active NPI
Chris M Grisaffi, BS
- Laboratory Management Specialist/Technologist
- Boise, ID
National Provider Identifier
1942697115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Laboratory Management Specialist/Technologist
- License
- P1869
- Practice address
- 1010 N Orchard St Ste 8
Boise, ID 83706-2255 - Phone
- (208) 331-4097
- Fax
- (208) 331-4095
- NPI assigned
- Apr 24, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Laboratory Management Specialist/Technologist | 246QL0900X | P1869 | ID | Primary |
Addresses
Primary practice location
1010 N Orchard St Ste 8
Boise, ID 83706-2255
Mailing address
1010 N Orchard St Ste 8
Boise, ID 83706-2255
Phone (208) 331-4097
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295917375 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P1869 | ID | MD | Laboratory Management Specialist/Technologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| United Drug Testing Laboratory, Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Medical Laboratory
- Boise, ID
- NPI 1295917375
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429833600000",
"number": "1942697115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1010 N ORCHARD ST STE 8",
"city": "BOISE",
"state": "ID",
"postal_code": "837062255",
"telephone_number": "208-331-4097",
"fax_number": "208-331-4095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 N ORCHARD ST STE 8",
"city": "BOISE",
"state": "ID",
"postal_code": "837062255",
"telephone_number": "208-331-4097",
"fax_number": "208-331-4095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRISAFFI",
"first_name": "CHRIS",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "BS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-04-24",
"last_updated": "2015-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "246QL0900X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Pathology, Laboratory Management",
"state": "ID",
"license": "P1869",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1295917375",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.