David E. Mangold, PA-C
Individual provider Active NPI Medical Physician Assistant · Kalispell, MT
NPI 1164533618 · NPPES record last updated Oct 17, 2024
Key facts
- NPI
- 1164533618
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 323 (MT)
- Practice address
- 20 Four Mile Dr Ste 2
Kalispell, MT 59901-2644 - Phone
- (406) 300-4882
- Fax
- (406) 257-2706
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 11
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Liberty County Hospital and Nursing Home Inc
Practice addresses (Care Compare)
418 W Monroe Ave
Chester, MT 59522-7835
Phone (406) 759-5194
95 Indian Trail Rd
Kalispell, MT 59901-2613
Phone (406) 300-4882
Hospital & facility affiliations
- Logan Health - Chester
- Logan Health Medical Center
- Benefis Hospitals Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040123000602 | MT | Practitioner - Physician Assistant | 8325940299 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 323 | MT | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Logan Health - Shelby | Current |
Accepting new patients | |
| Liberty County Hospital and Nursing Home, Inc | Current |
Accepting new patients | |
| 4 My Kids Family Practice PLLC | Past |
Accepting new patients |
Locations
670 Park Ave
Shelby, MT 59474
Phone (406) 434-3110
640 Park Ave
Shelby, MT 59474
Phone (406) 434-3200
Interoperability endpoints
- krmcmedicalrecords@krhdirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 323 | MT | Yes |
Addresses
Primary practice location
20 Four Mile Dr Ste 2
Kalispell, MT 59901-2644
Mailing address
20 Four Mile Dr Ste 2
Kalispell, MT 59901-2644
Phone (406) 300-4882
Other practice location 1
640 Park Ave
Shelby, MT 59474-1663
Phone (406) 434-3200
Other practice location 2
670 Park Ave
Shelby, MT 59474-1663
Phone (406) 966-7040
Other practice location 3
315 W Madison Ave
Chester, MT 59522-7801
Phone (406) 759-5181
Other practice location 4
418 W Monroe Ave
Chester, MT 59522-7835
Phone (406) 759-5181
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000094853 | Other | MT | BC/BS |
| 4302139 | Medicaid | MT |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Krmcmedicalrecords@krhdirect.org | Direct | Logan Health - Shelby |
| Direct Messaging Address | krmcmedicalrecords@krhdirect.org | Direct | Liberty County Hospital and Nursing Home, Inc |
Other providers in Kalispell, MT
- Stanley Harland Makman
- Jason Mallonee
- Kelly L Malmin
- Samuel Steele Maltby
- Joni Mamica
- Marci Rae Mangold
- Cassandra Manzer
- Douglas S Marbarger
- Lori Mariani
- Sara Marie
All providers in Kalispell, MT · Medical Physician Assistant in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.