Moccasin Mountain Health Clinic, Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MOCCASIN MOUNTAIN HEALTH CLINIC, INC

Practice address

629 NE Main St Ste 2
Lewistown, MT 59457-2082

Phone

(406) 321-2431

NPI assigned

Jul 10, 2024

Last updated

Jul 10, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Randi Rath, PANPI 1215478615

Title

Ceo

Phone

(406) 321-2431

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MT

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Randi Rath, PA-C

  • Physician Assistant
  • Scobey, MT
  • NPI 1215478615
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1720569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1053158766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 6TH AVE N",
            "city": "LEWISTOWN",
            "state": "MT",
            "postal_code": "594572125",
            "telephone_number": "406-321-2431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 NE MAIN ST STE 2",
            "city": "LEWISTOWN",
            "state": "MT",
            "postal_code": "594572082",
            "telephone_number": "406-321-2431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOCCASIN MOUNTAIN HEALTH CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-10",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A",
        "authorized_official_last_name": "RATH",
        "authorized_official_first_name": "RANDI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "406-321-2431",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joan M McMahon, MD
• Richard Bruce McMaster, OD
• Kensey Mikkelsen, DPT
• A'Lynn Mikkelson, LMT, AHAP, NCTMB
• Barbara Kim Miller, MD
• Donald K Moen, DDS
• Matthew Casper Moen, DMD
• Vanessa Moen, PT, DPT
• Maggie Moffatt, LCPC
• Montana Family Dentistry

• General Practice Physician in Lewistown, MT
• Providers in Lewistown, MT by specialty
• General Practice Physician in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.