Individual provider Active NPI

Camilla E Juhl-Petersen, MD

  • Family Medicine Physician
  • Missoula, MT
National Provider Identifier
1073809232
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MED-PHYS-LIC-49461 Issued in MT
Practice address
500 W Broadway St
Missoula, MT 59802-4008
Phone
(406) 543-7271
Fax
(406) 327-1834
NPI assigned
Jun 24, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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 6049 AK
Family Medicine Physician 207Q00000X MED-PHYS-LIC-49461 MT Primary

Addresses

Primary practice location

500 W Broadway St
Missoula, MT 59802-4008

Mailing address

500 West Broadway
Missoula, MT 59802-4008
Phone (406) 327-1918

Other practice location 1

600 Mt Highway 91 S
Dillon, MT 59725-7379
Phone (406) 683-3000

Other practice location 2

1101 26th St S
Great Falls, MT 59405-5161
Phone (406) 731-8888

Other identifiers 1

IdentifierTypeStateIssuer
MD9656MedicaidAK

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cjuhlpetersen87874@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jan 1, 2025 through Jan 1, 2027

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6049AKMDFamily Medicine Physician
MED-PHYS-LIC-49461MTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Barrett Hospital Development Corporation Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: cjuhlpetersen87874@wm.providencedirect.org
  • Direct secure messaging: camilla.juhl-petersen@489977005998084.direct.elationemr.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1308873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1073809232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 WEST BROADWAY",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008",
            "telephone_number": "406-327-1918",
            "fax_number": "406-549-2246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008",
            "telephone_number": "406-543-7271",
            "fax_number": "406-327-1834"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Mt Highway 91 S",
            "address_purpose": "LOCATION",
            "city": "Dillon",
            "state": "MT",
            "postal_code": "597257379",
            "country_code": "US",
            "telephone_number": "406-683-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1101 26th St S",
            "address_purpose": "LOCATION",
            "city": "Great Falls",
            "state": "MT",
            "postal_code": "594055161",
            "country_code": "US",
            "telephone_number": "406-731-8888",
            "fax_number": "406-731-8318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUHL-PETERSEN",
        "first_name": "CAMILLA",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-24",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "6049",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "MED-PHYS-LIC-49461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD9656",
            "state": "AK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cjuhlpetersen87874@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 W Broadway St",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.