KENRIC GLENN GORDON LMSW
NPI 1114540804
Social Worker in Chubbuck, ID

Q: What is Kenric Gordon's NPI number?

The NPI number for Kenric Gordon is 1114540804. It was assigned to this individual provider in the NPPES registry on May 28, 2020.

Q: What is Kenric Gordon's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Q: When was this NPI record last updated?

The NPPES record for Kenric Gordon was last updated on May 28, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 28, 2020PECOS Enrolled

210 W BURNSIDE AVE STE A, CHUBBUCK, ID 83202(208) 238-9000 Get Directions Write a Review

NPPES record last updated: May 28, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Kenric Glenn Gordon Lmsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENRIC GLENN GORDON LMSW (NPI 1114540804) is an individual social worker in Chubbuck, Idaho, licensed in Idaho (LMSW-39661) and active in the NPI registry since May 2020. He is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1114540804

Entity TypeIndividualMale

Primary Taxonomy104100000X

Provider Legal NameKENRIC GLENN GORDONCredential: LMSW

Location Address210 W BURNSIDE AVE STE AChubbuck, ID 83202-4916

Mailing Address210 W Burnside Ave Ste AChubbuck, ID 83202-4916 · (208) 238-9000

Phone(208) 238-9000

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateMay 28, 2020

NPPES CertifiedMay 28, 2020

✔ NPI 1114540804 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers

Taxonomy Code104100000X

License✔ Licensed in ID · LMSW-39661

Definition

A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.

210 W BURNSIDE AVE STE A, Chubbuck, ID 83202

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., Molina Healthcare, PacificSource Health Plans and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kenric Glenn Gordon Lmsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9032579396

PECOS Enrollment IDI20230718002486

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kenric Gordon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Mental Health Specialists

0.3 mi

Clinical

210 W BURNSIDE AVE, SUITE A
Chubbuck, ID 83202

Reassigned Medicare billing, Idaho enrollment
16 clinicians in this Medicare group

NPI 1548585458 (208) 238-9000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. JAMES F BAKAITIS LCPC

Counselor (Professional)

210 W BURNSIDE AVE STE A
CHUBBUCK, ID 83202

Bannock County (313) 383-0033

RAMONA L. MEDICINE HORSE LMSW

Social Worker (Clinical)

210 W BURNSIDE AVE STE A
CHUBBUCK, ID 83202

Bannock County (208) 238-9000

SAEWARD O'NEILL LPC

Counselor (Mental Health)

210 W BURNSIDE AVE STE A
POCATELLO, ID 83202

Bannock County (208) 238-9000

STEPHANIE LEE BRANNON LCPC

Counselor (Professional)

210 W BURNSIDE AVE STE A
CHUBBUCK, ID 83202

Bannock County (208) 238-9000

KAYLA R FRANDSEN LMSW

Social Worker (Clinical)

210 W BURNSIDE AVE STE A
CHUBBUCK, ID 83202

Bannock County (208) 238-9000

THOMAS PUTNAM LPC

Counselor (Mental Health)

210 W BURNSIDE AVE STE A
CHUBBUCK, ID 83202

Bannock County (208) 238-9000

RUTH NIELSON ADAMSON LMSW-380

Counselor (Mental Health)

210 W BURNSIDE AVE STE A
CHUBBUCK, ID 83202

Bannock County (208) 238-9000

DR. ERIN KATHLEEN SULLIVAN BAKER RN M COUN,LPC MS PHD

Counselor (Mental Health)

210 W BURNSIDE AVE STE A
CHUBBUCK, ID 83202

Bannock County (208) 233-2051

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenric Gordon's NPI number?

The NPI number for Kenric Gordon is 1114540804. It was assigned to this individual provider in the NPPES registry on May 28, 2020.

Where is Kenric Gordon located?

Kenric Gordon practices at 210 W Burnside Ave Ste A, Chubbuck, ID 83202. The listed phone number is (208) 238-9000.

What is Kenric Gordon's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Is Kenric Gordon enrolled in Medicare?

Yes. Kenric Gordon is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kenric Gordon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kenric Gordon reassigns Medicare benefits to Mental Health Specialists (Chubbuck, ID). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kenric Gordon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kenric Gordon accept?

Health plans from Moda Health Plan, Inc., Molina Healthcare, PacificSource Health Plans and University of Utah Health Plans list Kenric Gordon as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kenric Gordon was last updated on May 28, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.