Active NPI
Thomas J Clucas, PHD
- Psychologist
- Mussoula, MT
National Provider Identifier
1083763643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- MT186
- Practice address
- 125 Bank Street
Suite 310
Mussoula, MT 59802 - Phone
- (406) 549-7325
- Fax
- (406) 549-7559
- NPI assigned
- Jan 10, 2007
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | MT186 | MT | Primary |
Addresses
Primary practice location
125 Bank Street
Suite 310
Mussoula, MT 59802
Mailing address
125 Bank Street
Suite 310
Mussoula, MT 59802
Phone (406) 549-7325
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51981 | Other | MT | BLUE CROSS BLUE SHIELD |
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT186 | MT | MD | Psychologist |
| 186 | MT | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Montana Neurobehavioral Specialists | 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.
-
- Neurology Physician
- Missoula, MT
- NPI 1013961671
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207785600000",
"number": "1083763643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 BANK STREET",
"address_2": "SUITE 310",
"city": "MUSSOULA",
"state": "MT",
"postal_code": "59802",
"telephone_number": "406-549-7325",
"fax_number": "406-549-7559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 BANK STREET",
"address_2": "SUITE 310",
"city": "MUSSOULA",
"state": "MT",
"postal_code": "59802",
"telephone_number": "406-549-7325",
"fax_number": "406-549-7559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLUCAS",
"first_name": "THOMAS",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2008-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MT",
"license": "MT186",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "51981",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.