Alyson Anne Thede, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

12229855-1205 Issued in UT

Practice address

815 N 5TH Ave Unit 202
Bozeman, MT 59715-2884

Phone

(406) 545-2555

Fax

(406) 545-2554

NPI assigned

May 24, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Alyson Endicott Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Indiana University School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Epiphany Dermatology of Montana PLLCGroup PAC ID 9537593710, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bozeman Health Deaconess Hospital Hospital, Bozeman, MT, CCN 270057

Merit-based Incentive Payment System (MIPS)

Final score

91.16 of 100Reported as group

Quality

92.95

Improvement activities

40

Cost

79.95

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: alyson.thede@epiphanyderm.emadirect.md

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.

• Epiphany Dermatology of Montana, PLLC

  • Dermatology Physician
  • Butte, MT
  • NPI 1902455074
  Medicare reassignment Care Compare group NPD
• Guardian Dermatology

  • Dermatology Physician
  • Helena, MT
  • NPI 1972172328
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bozeman Health Deaconess Hospital

  • General Acute Care Hospital
  • Bozeman, MT
  • NPI 1104295864
  Care Compare affiliation

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

{
    "created_epoch": "1495584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1003344862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 RANCH ROAD 2222, BUILDING 1, STE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78730",
            "telephone_number": "512-628-0465",
            "fax_number": "512-233-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 N 5TH AVE UNIT 202",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597152884",
            "telephone_number": "406-545-2555",
            "fax_number": "406-545-2554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 N 1900 E Rm 4A330",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841320002",
            "country_code": "US",
            "telephone_number": "801-581-6465",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1960 N Ogden St Ste 400",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802183670",
            "country_code": "US",
            "telephone_number": "303-318-1570",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24 E Broadway St",
            "address_purpose": "LOCATION",
            "city": "Butte",
            "state": "MT",
            "postal_code": "597019334",
            "country_code": "US",
            "telephone_number": "406-723-7272",
            "fax_number": "406-723-3328",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Park Dr # 201B",
            "address_purpose": "LOCATION",
            "city": "Helena",
            "state": "MT",
            "postal_code": "596018022",
            "country_code": "US",
            "telephone_number": "406-443-7200",
            "fax_number": "406-443-7201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEDE",
        "first_name": "ALYSON",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-24",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "UT",
            "license": "12229855-1205",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "UT",
            "license": "12229855-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aendicott510428@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ALYSON",
            "last_name": "ENDICOTT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Dermatology Physician in Bozeman, MT
• Providers in Bozeman, MT by specialty
• Dermatology Physician in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; 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.