Kylie Gagnon Randall, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Practice address

104 N Trautman Ave
Broadus, MT 59317-7504

Phone

(406) 436-2646

NPI assigned

Feb 25, 2018

Last updated

Jun 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kylie Ann Gagnon Former name

Medicare fee-for-service enrollment

Enrolled in MT

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Powder River CountyGroup PAC ID 2860543667, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12906/brand/1/csg/1/fhir/r4

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Powder River County

  dba Powder River Manor

  • Skilled Nursing Facility
  • Broadus, MT
  • NPI 1386611747

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Powder River County

  dba Powder River Manor

  • Skilled Nursing Facility
  • Broadus, MT
  • NPI 1386611747
  Medicare reassignment Care Compare group NPD
• Bridger Orthopedics and Sports Medicine, PC

  dba Bridger Orthopedic and Sports Medicine

  • Orthopaedic Surgery Physician
  • Bozeman, MT
  • NPI 1750310926
  Medicare reassignment NPD
• Powder River County

  dba Powder River Manor

  • Multi-Specialty Clinic/Center
  • Broadus, MT
  • NPI 1801234141
  NPD

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

{
    "created_epoch": "1519516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1114428133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 STUCKY RD",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597187557",
            "telephone_number": "406-581-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 N TRAUTMAN AVE",
            "city": "BROADUS",
            "state": "MT",
            "postal_code": "593177504",
            "telephone_number": "406-436-2646"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1450 Ellis St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Bozeman",
            "state": "MT",
            "postal_code": "597158813",
            "country_code": "US",
            "telephone_number": "406-556-9110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "KYLIE",
        "middle_name": "GAGNON",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-25",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OT LICENCE",
            "identifier": "5456",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYLIE",
            "last_name": "GAGNON",
            "middle_name": "ANN",
            "credential": "OT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Powder River County (Powder River Public Health)
• Powder River County (Powder River Manor)
• Powder River County (Powder River Medical Clinic)
• Powder River County District High School
• Powder River Publichealth
• Rhonda Rae Rosencranz, MPT
• Jami Jo Schroeder, PHARM.D.
• Cherie Stachey, RN
• The Body Shop Physical Therapy
• Tri-County Special Education Cooperative

• Occupational Therapist in Broadus, MT
• Providers in Broadus, MT by specialty
• Occupational Therapist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.