Alexis Vantiem, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MED-PAC-LIC-145618 Issued in MT

Practice address

1208 6TH Ave. E
Superior, MT 59872

Phone

(406) 822-4803

Fax

(406) 822-3848

NPI assigned

Jul 6, 2023

Last updated

Dec 1, 2025By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Missoula Community Health Services, Inc.

  • Family Medicine Physician
  • Saint Regis, MT
  • NPI 1225836554
  Medicare reassignment NPD
• Missoula Community Health Services, Inc.

  dba Mineral Community Hospital

  • Critical Access Hospital
  • Superior, MT
  • NPI 1902990005
  Medicare reassignment NPD
• Missoula Community Health Services, Inc

  dba Tamarack Medical Clinic

  • General Practice Physician
  • Superior, MT
  • NPI 1710165105
  Medicare reassignment
• Missoula Community Health Services, Inc

  dba Mineral Community Hospital Clinic

  • Multi-Specialty Clinic/Center
  • Superior, MT
  • NPI 1073080461
  NPD

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

{
    "created_epoch": "1688601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764547200000",
    "number": "1124706627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 66",
            "city": "SUPERIOR",
            "state": "MT",
            "postal_code": "59872",
            "telephone_number": "406-822-4803",
            "fax_number": "406-822-3848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 6TH AVE. E",
            "city": "SUPERIOR",
            "state": "MT",
            "postal_code": "59872",
            "telephone_number": "406-822-4803",
            "fax_number": "406-822-3848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANTIEM",
        "first_name": "ALEXIS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-06",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "MED-PAC-LIC-145618",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Superior Elementary School
• Superior High School
• Superior Volunteer Fire Company Inc (Superior Area Ambulance Service)
• Terry a. Smith M.C.P.C. (ponderosa medical clinic)
• Threshold Movement Therapy & Coaching, PLLC
• Jacob Whetzel
• Gary Tibbett Woodson, R.PH.

• Physician Assistant in Superior, MT
• Providers in Superior, MT by specialty
• Physician Assistant in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.