Alpine Orthopedics & Sports Medicine
Organization Active NPI Sports Medicine (Orthopaedic Surgery) Physician · Bozeman, MT
NPI 1083626832 · NPPES record last updated Oct 27, 2011
Key facts
- NPI
- 1083626832
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X
- Legal business name
- ALPINE ORTHOPEDICS & SPORTS MEDICINE
- Practice address
- 536 Cottonwood Rd
Suite 100
Bozeman, MT 59718 - Phone
- (406) 586-8029
- Fax
- (406) 586-8009
- NPI assigned
- Aug 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Mark C Deibert, MD
- Title
- President
- Phone
- (406) 586-8029
Practitioners 16
-
Mark C Deibert, MD
-
Virginia R Jeppesen, NP-C
-
Peter M Kelleher, MD
-
Timothy O'Brien, MD
-
Dean C Sukin, M.D.
-
Justyna Wojtyczka, PA-C
-
Joshua Lupine Spuhler, PA-C
-
Rebekah E Garrison, PA-C
-
Jeffrey S Rasch, DO
-
Charlene Laura Ward, FNP-BC
-
Emily C Harnden, M.D.
-
Stephen George Reichard, M.D.
-
Anthony Robert Stark, D.O.
-
Jessica Ann Pelton, PA-C
-
Erik L Schroeder, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040907001208 | MT | Part B Supplier - Clinic/Group Practice | 7113993577 |
Receives reassigned benefits from 15 practitioners Practice locations: Bozeman, MT |
| O20100930053439 | MT | DME Supplier - Physician - Orthopedic/Orthopedic Surgery | 7113993577 | Practice locations: Bozeman, MT |
National Provider Directory
Locations
536 S Cottonwood Rd
Ste 10
Bozeman, MT 59718
Phone (406) 586-8029
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician |
207QS0010X | |||
| Sports Medicine (Orthopaedic Surgery) Physician |
207XX0005X | Yes | ||
| Sports Medicine (Orthopaedic Surgery) Physician |
207XX0005X | 8221 | MT | |
| Orthopaedic Trauma Physician |
207XX0801X | |||
| Medical Physician Assistant |
363AM0700X | |||
| Surgical Physician Assistant |
363AS0400X |
Addresses
Primary practice location
536 Cottonwood Rd
Suite 100
Bozeman, MT 59718
Mailing address
536 Cottonwood Rd
Suite 100
Bozeman, MT 59718
Phone (406) 586-8029
Other providers in Bozeman, MT
- Ally Psychiatric Wellness
- Meira Aliza Alon
- Alpenglow Family Dentistry PLLC
- Alpine Counseling LLC
- Alpine Orthopedics
- Alpine Physicians Health Center
- Rhonda Alsobrook
- Alta Physical Therapy & Fitness Inc
- Linda Kay Altans
- Katharine C Althans
All providers in Bozeman, MT · Sports Medicine (Orthopaedic Surgery) Physician in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.