Active NPI
Gary Edward Jimmerson, DC
- Chiropractor
- Fort Benton, MT
National Provider Identifier
1053473397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 600
- Practice address
- 1309 Front St
Fort Benton, MT 59442 - Phone
- (406) 622-5598
- Fax
- (406) 622-9090
- NPI assigned
- Dec 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 600 | MT | Primary |
Addresses
Primary practice location
1309 Front St
Fort Benton, MT 59442
Mailing address
PO Box 1477
Fort Benton, MT 59442-1477
Phone (406) 622-5598
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40110 | Other | GREAT FALLS BC INS | |
| 04007720 | Other | MT | STATE FUND WORKERS COMP |
| 42360 | Other | MT | FORT BENTON BC INS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 600 | MT | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellness Chiropractic Clinic PC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Chiropractor
- Great Falls, MT
- NPI 1750859559
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588118400000",
"number": "1053473397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1477",
"city": "FORT BENTON",
"state": "MT",
"postal_code": "594421477",
"telephone_number": "406-622-5598",
"fax_number": "406-622-9090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1309 FRONT ST",
"city": "FORT BENTON",
"state": "MT",
"postal_code": "59442",
"telephone_number": "406-622-5598",
"fax_number": "406-622-9090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIMMERSON",
"first_name": "GARY",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-14",
"last_updated": "2020-04-29",
"certification_date": "2020-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MT",
"license": "600",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT FALLS BC INS",
"identifier": "40110",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE FUND WORKERS COMP",
"identifier": "04007720",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FORT BENTON BC INS",
"identifier": "42360",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Benton, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.