NPIMap

Organization Active NPI

Bates Family Diversified, LLC

  • Rural Health Clinic/Center
  • Three Forks, MT
National Provider Identifier
1003466822
Registry record updated Aug 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BATES FAMILY DIVERSIFIED, LLC
Practice address
16 Railway Ave
Three Forks, MT 59752-9080
Phone
(406) 285-3251
Fax
(406) 285-6742
NPI assigned
Sep 13, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2020

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

Authorized official

Name
Cynthia A Bates, FNP-BC
Title
Owner
Phone
(406) 285-3251

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

16 Railway Ave
Three Forks, MT 59752-9080

Mailing address

16 Railway Ave
Three Forks, MT 59752-9080
Phone (406) 285-3251

Other names 1

  • Three Rivers Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191112001070 MT Part A Provider - Rural Health Clinic 6406288547 Practice locations: Three Forks, MT
O20200225002889 MT Part B Supplier - Clinic/Group Practice 6406288547 Receives reassigned benefits from 7 practitioners
Practice locations: Three Forks, MT

Rural health clinic certification: CCN 273824

Legal name
BATES FAMILY DIVERSIFIED LLC
Doing business as
THREE RIVERS CLINIC/THREE RIVERS MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 28, 2001
Last certification
Jul 21, 2025
Ownership / control type
1B
Most recent change of ownership
Oct 1, 2019 (2 total)
Organization structure
LLCProprietary
Incorporated
Sep 5, 2019 in MT
Enrollment address
16 Railway Avenue
Three Forks, MT 59752-9080

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
27D0696973Bates Family Diversified, LLC16 Railway Avenue, Three Forks, MT 59752Certificate of waiverJul 29, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Malori Anderson Individual W-2 Managing EmployeeOffice Manager Dec 7, 2016
Lauren M McKay Individual 5% Or Greater Direct Ownership InterestOwner Feb 20, 2025 100%
James C Larsen Individual Contracted Managing EmployeeMedical Director Oct 1, 2019

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Change-of-ownership history 1

DateEventCounterparty
Oct 1, 2019 Change of OwnershipThis provider was the buyer Three Rivers Clinic, LLCCCN 273824, MT, NPI 1851425789

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1568332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597363200000",
    "number": "1003466822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 RAILWAY AVE",
            "city": "THREE FORKS",
            "state": "MT",
            "postal_code": "597529080",
            "telephone_number": "406-285-3251",
            "fax_number": "406-285-6742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 RAILWAY AVE",
            "city": "THREE FORKS",
            "state": "MT",
            "postal_code": "597529080",
            "telephone_number": "406-285-3251",
            "fax_number": "406-285-6742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BATES FAMILY DIVERSIFIED, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-13",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A",
        "authorized_official_last_name": "BATES",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-285-3251",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Three Rivers Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Three Rivers Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Three Forks, MT

Sources for this page

Verify at the official NPI Registry.