Edred T Vizcarra, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

6860 Issued in MT

Practice address

126 6TH Ave SW
Ronan, MT 59864-2600

Phone

(406) 676-3600

Fax

(406) 676-3738

NPI assigned

Dec 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 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

Family Practice

Education

Loma Linda University School of Medicine, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Lukes Community HospitalGroup PAC ID 5496659567, 59 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Partners in Home Care Inc Home health agency, Missoula, MT, CCN 277032
• St Luke Community Hospital Hospital, Ronan, MT, CCN 271325

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• St Lukes Community Hospital

  • Rural Health Clinic/Center
  • Polson, MT
  • NPI 1548612096

  Corporate Director

  CMS ownership
• St. Lukes Community Hospital

  • Rural Health Clinic/Center
  • Ronan, MT
  • NPI 1093876344

  Corporate Director

  CMS ownership
• St. Lukes Community Hospital

  • Rural Health Clinic/Center
  • Polson, MT
  • NPI 1184785420

  Corporate Director

  CMS ownership

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.

• St. Lukes Community Hospital

  • Rural Health Clinic/Center
  • St. Ignatius, MT
  • NPI 1306911169

  Family Medicine

  Medicare reassignment Care Compare group NPD
• St Lukes Community Hospital

  • Family Medicine Physician
  • Ronan, MT
  • NPI 1316125677
  NPD
• St Lukes Community Hospital

  • Certified Registered Nurse Anesthetist
  • Ronan, MT
  • NPI 1518663608
  NPD

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

• Partners in Home Care, Inc.

  • Home Health Agency
  • Missoula, MT
  • NPI 1629135447
  Care Compare affiliation
• St Lukes Community Hospital

  • Critical Access Hospital
  • Ronan, MT
  • NPI 1336213446
  Care Compare affiliation

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043373111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48767 ROCKY BUTTE RD",
            "city": "RONAN",
            "state": "MT",
            "postal_code": "598648897",
            "telephone_number": "406-676-0432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 6TH AVE SW",
            "city": "RONAN",
            "state": "MT",
            "postal_code": "598642600",
            "telephone_number": "406-676-3600",
            "fax_number": "406-676-3738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIZCARRA",
        "first_name": "EDRED",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "6860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101257",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Eve Tolbert, MA CCC SLPA
• Dennis Toney
• Karissa Renee Louise Trahan, MSW
• Lauren Marcus Velk, C.R.N.A.
• Megan A Vigil, M.D.
• Marvin Walter Walchuk, C-PED
• Leslie Ann Wallace, OT
• Zachary Weijohn, DPT
• Western Montana Family Dentistry
• Chris Westphal, RNFA

• Family Medicine Physician in Ronan, MT
• Providers in Ronan, MT by specialty
• Family Medicine Physician in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.