Active NPI
Pamela B Peterson, NP
- Family Nurse Practitioner
- Missoula, MT
National Provider Identifier
1073656682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- RN18519
- Practice address
- 2360 Mullan Rd Ste C
Missoula, MT 59808-1811 - Phone
- (406) 721-4436
- Fax
- (406) 542-1037
- NPI assigned
- Feb 14, 2007
- Last updated
- Aug 26, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN18519 | MT | Primary |
Addresses
Primary practice location
2360 Mullan Rd Ste C
Missoula, MT 59808-1811
Mailing address
2360 Mullan Rd Ste C
Missoula, MT 59808-1811
Phone (406) 721-4436
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500027942 CK5082 | Other | RAILROAD MEDICARE | |
| 806516800 | Medicaid | ID | |
| 000372730 | Other | MT | BLUE CROSS BLUE SHIELD |
| 0439998 | Medicaid | MT |
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN18519 | MT | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Health & Services Mt | Past | Accepting new patients | |
| Center for Joint Care PLLC | Family | Past | Accepting new patients |
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.
-
dba Providence Medical Group Montana
- Family Medicine Physician
- Missoula, MT
- NPI 1215222617
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409011200000",
"number": "1073656682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2360 MULLAN RD STE C",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598081811",
"telephone_number": "406-721-4436",
"fax_number": "406-542-1037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2360 MULLAN RD STE C",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598081811",
"telephone_number": "406-721-4436",
"fax_number": "406-542-1037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "PAMELA",
"middle_name": "B",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-14",
"last_updated": "2014-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MT",
"license": "RN18519",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "500027942 CK5082",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "806516800",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "000372730",
"state": "MT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0439998",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.