NPIMap

Individual provider Active NPI

John Merrill Neathawk, D.O.

  • Internal Medicine Physician
  • Missoula, MT
National Provider Identifier
1134567126
Registry record updated Mar 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
49722 Issued in MT
Practice address
500 W Broadway St
Room 202 Main Hospital, MSC 333
Missoula, MT 59802-4008
Phone
(406) 543-7271
Fax
(406) 327-1834
NPI assigned
Jun 12, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 49722 MT Primary

Addresses

Primary practice location

500 W Broadway St
Room 202 Main Hospital, MSC 333
Missoula, MT 59802-4008

Mailing address

PO Box 12
Liberty Lake, WA 99019-0012
Phone (866) 747-2455

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
I20160908000805 MT Practitioner - HospitalistPractitioner - Internal Medicine 2668694548 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2013
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
SPH Inpatient Phy Services
Missoula, MT 59802-4096
Phone (406) 543-7271

Hospital & facility affiliations

  • St. Patrick Hospital Hospital, Missoula, MT, CCN 270014
  • Bitterroot Health - Daly Hospital Hospital, Hamilton, MT, CCN 271340
  • Providence St Joseph Medical Center Hospital, Polson, MT, CCN 271343
  • Clark Fork Valley Hospital Hospital, Plains, MT, CCN 271323
  • St James Hospital Hospital, Butte, MT, CCN 270017

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49722MTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence St Joseph Medical Center CurrentSince Mar 1, 2019 Accepting new patients
Providence Health & Services Mt Internal Medicine CurrentSince Aug 22, 2016 Accepting new patients
Credena Health LLC CurrentSince Mar 1, 2019 Accepting new patients
Providence Health & Services Mt Internal Medicine CurrentSince Aug 22, 2016 Accepting new patients
Providence Health & Services Mt Current Accepting new patients
Providence Health & Services Mt Past Accepting new patients

Locations

500 W Broadway St
Rm 202
Missoula, MT 59802

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

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

6 13th Ave E
Polson, MT 59860
Phone (406) 883-5377

63351 US Highway 93
Ronan, MT 59864
Phone (406) 676-5680

Organizations & group practices 6

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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1370995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522108800000",
    "number": "1134567126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190012",
            "telephone_number": "866-747-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST",
            "address_2": "ROOM 202 MAIN HOSPITAL, MSC 333",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008",
            "telephone_number": "406-543-7271",
            "fax_number": "406-327-1834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEATHAWK",
        "first_name": "JOHN",
        "middle_name": "MERRILL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-12",
        "last_updated": "2018-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MT",
            "license": "49722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.