NPIMap

Individual provider Active NPI

Jennie Walker Eckstrom, M.D.

  • Family Medicine Physician
  • Whitefish, MT
National Provider Identifier
1003867037
Registry record updated May 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10784 Issued in MT
Practice address
1111 Baker Ave
Glacier Medical Associates
Whitefish, MT 59937-2901
Phone
(406) 862-2515
Fax
(406) 862-4229
NPI assigned
May 15, 2006
Last updated
May 12, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M9143 ID
Family Medicine Physician 207Q00000X 10784 MT Primary

Addresses

Primary practice location

1111 Baker Ave
Glacier Medical Associates
Whitefish, MT 59937-2901

Mailing address

1111 Baker Ave
Glacier Medical Associates
Whitefish, MT 59937-2901
Phone (406) 862-2515

Other identifiers 9

IdentifierTypeStateIssuer
10784OtherMTMONTANA STATE LICENSE
CI2709OtherMTRAILROAD MEDICARE GRP ID#
000094766OtherMTBLUE CROSS/SHIELD PIN
0143442MedicaidMT
1104882232OtherMTGLACIER MEDICAL ASSOC NPI
810350909OtherMTFEIN
000008287OtherMTMEDICARE PART B GRP ID#
P00234037OtherMTRAILROAD MEDICARE PIN#
27D0411341OtherMTCLIA ID#--LAB CERT

Other names 1

  • Jennie Kay Walker Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050620000339 MT Practitioner - Family Practice 7719921865 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Glacier Medical AssociatesGroup PAC ID 7911981188, 23 clinicians

Practice addresses (Care Compare)

1111 Baker Ave
Whitefish, MT 59937-2901
Phone (406) 862-2515

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
58.05 of 100Reported as apm
Quality
70.8
Promoting interoperability
0
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Removal of skin lesions21
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M9143IDMDFamily Medicine Physician
10784MTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Glacier Medical Associates Family Medicine CurrentSince Jun 27, 2005 Accepting new patients
Glacier Medical Associates Family Medicine Past Accepting new patients

Locations

500 12th Ave W
Columbia Falls, MT 59912
Phone (406) 257-2020

500 12th Ave W
Ste 1B
Columbia Fls, MT 59912

2310 US Highway 2 E
Ste 4
Kalispell, MT 59901
Phone (406) 862-2515

1111 Baker Ave
Uppr
Whitefish, MT 59937
Phone (406) 407-7990

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210550400000",
    "number": "1003867037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 BAKER AVE",
            "address_2": "GLACIER MEDICAL ASSOCIATES",
            "city": "WHITEFISH",
            "state": "MT",
            "postal_code": "599372901",
            "telephone_number": "406-862-2515",
            "fax_number": "406-862-4229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 BAKER AVE",
            "address_2": "GLACIER MEDICAL ASSOCIATES",
            "city": "WHITEFISH",
            "state": "MT",
            "postal_code": "599372901",
            "telephone_number": "406-862-2515",
            "fax_number": "406-862-4229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ECKSTROM",
        "first_name": "JENNIE",
        "middle_name": "WALKER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-15",
        "last_updated": "2008-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M9143",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "10784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MONTANA STATE LICENSE",
            "identifier": "10784",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GRP ID#",
            "identifier": "CI2709",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/SHIELD PIN",
            "identifier": "000094766",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0143442",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GLACIER MEDICAL ASSOC NPI",
            "identifier": "1104882232",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEIN",
            "identifier": "810350909",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B GRP ID#",
            "identifier": "000008287",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN#",
            "identifier": "P00234037",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA ID#--LAB CERT",
            "identifier": "27D0411341",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIE",
            "last_name": "WALKER",
            "middle_name": "KAY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Whitefish, MT

Sources for this page

Verify at the official NPI Registry.