Active NPI
Matthew C. Crootof, PA-C
- Physician Assistant
- Bozeman, MT
National Provider Identifier
1154879054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- MED-PAC-LIC-51009
- Practice address
- 1104 E Main St
Bozeman, MT 59715-3884 - Phone
- (406) 587-3788
- NPI assigned
- Sep 20, 2016
- Last updated
- Sep 20, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MED-PAC-LIC-51009 | MT | Primary |
Addresses
Primary practice location
1104 E Main St
Bozeman, MT 59715-3884
Mailing address
1104 E Main St
Bozeman, MT 59715-3884
Phone (406) 587-3788
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MED-PAC-LIC-51009 | MT | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474329600000",
"number": "1154879054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1104 E MAIN ST",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597153884",
"telephone_number": "406-587-3788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1104 E MAIN ST",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597153884",
"telephone_number": "406-587-3788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROOTOF",
"first_name": "MATTHEW",
"middle_name": "C.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-20",
"last_updated": "2016-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MT",
"license": "MED-PAC-LIC-51009",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bozeman, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.