NPIMap

Organization Active NPI

Greater Good Health PC, Inc.

  • Primary Care Clinic/Center
  • Missoula, MT
National Provider Identifier
1104503168
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
GREATER GOOD HEALTH PC, INC.
Practice address
2230 N Reserve St Ste 110
Missoula, MT 59808-1364
Phone
(310) 658-3775
NPI assigned
Jun 30, 2023
Last updated
Oct 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Authorized official

Name
Sylvia Hastanan
Title
Vice President
Phone
(310) 795-8807

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary
Primary Care Nurse Practitioner 363LP2300X NU

Addresses

Primary practice location

2230 N Reserve St Ste 110
Missoula, MT 59808-1364

Mailing address

300 Continental Blvd Ste 635
El Segundo, CA 90245-5040
Phone (310) 658-3775

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231024001501 MT Part B Supplier - Clinic/Group Practice 5294106027 Receives reassigned benefits from 14 practitioners
3 other NPIs on this enrollment
Practice locations: Billings, MT; Missoula, MT; Great Falls, MT

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Greater Good Health PC Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

405 3rd St NW
Unit 102
Great Falls, MT 59404
Phone (310) 658-3775

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1688083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698710400000",
    "number": "1104503168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CONTINENTAL BLVD STE 635",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902455040",
            "telephone_number": "310-658-3775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 N RESERVE ST STE 110",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081364",
            "telephone_number": "310-658-3775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER GOOD HEALTH PC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-30",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A",
        "authorized_official_last_name": "HASTANAN",
        "authorized_official_first_name": "SYLVIA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "310-795-8807"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Oct 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.