NPIMap

Organization Active NPI

Glacier Medical Associates

  • Family Medicine Physician
  • Whitefish, MT
National Provider Identifier
1104882232
Registry record updated Mar 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GLACIER MEDICAL ASSOCIATES
Practice address
1111 Baker Ave
Whitefish, MT 59937-2901
Phone
(406) 862-2515
Fax
(406) 862-4229
NPI assigned
Apr 26, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Ms. Kelli D Meuchel
Title
Practice Administrator
Phone
(406) 862-2515

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040615001387 MT Part B Supplier - Clinic/Group Practice 7911981188 Receives reassigned benefits from 28 practitioners
Practice locations: Whitefish, MT

National Provider Directory

National Provider Directory

Locations

500 12th Ave W
Ste 1B
Columbia Fls, MT 59912

2310 US Highway 2 E
Ste 4
Kalispell, MT 59901
Phone (406) 862-2515

2310 US Highway 2 E
Kalispell, MT 59901

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

NPPES NPI Registry

Primary practice location

1111 Baker Ave
Whitefish, MT 59937-2901

Mailing address

1111 Baker Ave
Whitefish, MT 59937-2901
Phone (406) 862-2515

Other identifiers 4

NPPES NPI Registry
IdentifierTypeStateIssuer
1104882232OtherMTGLACIER MEDICAL ASSOC NPI
27D0411341OtherMTCLIA ID#--LAB CERT
99882551MedicaidMT
0026899OtherWAWASH. DEP LABOR GRP ID#

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 25, 2014.

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395705600000",
    "number": "1104882232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 BAKER AVE",
            "city": "WHITEFISH",
            "state": "MT",
            "postal_code": "599372901",
            "telephone_number": "406-862-2515",
            "fax_number": "406-862-4229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 BAKER AVE",
            "city": "WHITEFISH",
            "state": "MT",
            "postal_code": "599372901",
            "telephone_number": "406-862-2515",
            "fax_number": "406-862-4229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIER MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2014-03-25",
        "status": "A",
        "authorized_official_last_name": "MEUCHEL",
        "authorized_official_first_name": "KELLI",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "406-862-2515",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GLACIER MEDICAL ASSOC NPI",
            "identifier": "1104882232",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA ID#--LAB CERT",
            "identifier": "27D0411341",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99882551",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASH. DEP LABOR GRP ID#",
            "identifier": "0026899",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whitefish, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; 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.