NPIMap

Individual provider Active NPI

Vicente Jose Undurraga Perl, M.D.

  • Surgical Critical Care Physician
  • Missoula, MT
National Provider Identifier
1083931067
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
MED-PHYS-LIC-113704 Issued in MT
Practice address
500 W Broadway St FL 4
Missoula, MT 59802-4008
Phone
(406) 329-5828
Fax
(406) 329-5864
NPI assigned
Apr 29, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X M-14232 ID
Surgical Critical Care Physician 2086S0102X MED-PHYS-LIC-113704 MT Primary

Addresses

Primary practice location

500 W Broadway St FL 4
Missoula, MT 59802-4008

Mailing address

PO Box 31001-4110
Pasadena, CA 91110-4110
Phone (406) 329-5828

Other practice location 1

999 N Curtis Road
Ste 415
Boise, ID 83706
Phone (208) 302-2600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220928001701 MT Practitioner - General Surgery 1951548940 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Perelman School of Med at the University of Pennsylvania, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians

Practice addresses (Care Compare)

500 W Broadway St
Missoula, MT 59802-4096
Phone (406) 329-5838

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MED-PHYS-LIC-113704MTMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt CurrentSince Nov 7, 2022 Accepting new patients
Providence Health & Services Mt Surgery CurrentSince Nov 7, 2022 Accepting new patients
Providence Health & Services Mt Current Accepting new patients
Providence Health & Services Mt Past Accepting new patients

Locations

500 W Broadway St
Fl 5
Missoula, MT 59802
Phone (406) 329-5866

500 W Broadway St
Ste 320
Missoula, MT 59802
Phone (406) 329-2945

500 W Broadway St
Fl 4
Missoula, MT 59802
Phone (406) 327-1900

500 W Broadway St
Missoula, MT 59802
Phone (406) 327-1918

Interoperability endpoints

  • Direct secure messaging: vundurragaperl150412@direct.trinity-health.org

Organizations & group practices 4

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1272499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748908800000",
    "number": "1083931067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4110",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104110",
            "telephone_number": "406-329-5828",
            "fax_number": "406-329-5864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST FL 4",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008",
            "telephone_number": "406-329-5828",
            "fax_number": "406-329-5864"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "999 N Curtis Road",
            "address_2": "Ste 415",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "83706",
            "country_code": "US",
            "telephone_number": "208-302-2600",
            "fax_number": "208-302-2625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "UNDURRAGA PERL",
        "first_name": "VICENTE",
        "middle_name": "JOSE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-29",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ID",
            "license": "M-14232",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MT",
            "license": "MED-PHYS-LIC-113704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.