NPIMap

Individual provider Active NPI

David E. Mangold, PA-C

  • Medical Physician Assistant
  • Kalispell, MT
National Provider Identifier
1164533618
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
323 Issued in 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
Last updated
Oct 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 323 MT Primary

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

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address Krmcmedicalrecords@krhdirect.org Direct Logan Health - Shelby
Direct Messaging Address krmcmedicalrecords@krhdirect.org Direct Liberty County Hospital and Nursing Home, Inc

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
I20040123000602 MT Practitioner - Physician Assistant 8325940299 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
323MTMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Liberty County Hospital and Nursing Home, Inc CurrentSince Dec 3, 2024 Accepting new patients
Logan Health - Shelby CurrentSince Sep 9, 2024 Accepting new patients
4 My Kids Family Practice PLLC PastSince Jul 24, 2022 Accepting new patients

Locations

640 Park Ave
Shelby, MT 59474
Phone (406) 434-3200

670 Park Ave
Shelby, MT 59474
Phone (406) 434-3110

Interoperability endpoints

  • Direct secure messaging: krmcmedicalrecords@krhdirect.org

Organizations & group practices 5

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.

Hospital & facility affiliations 11

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1164533618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 FOUR MILE DR STE 2",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599012644",
            "telephone_number": "406-300-4882",
            "fax_number": "406-257-2706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 FOUR MILE DR STE 2",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599012644",
            "telephone_number": "406-300-4882",
            "fax_number": "406-257-2706"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Shelby",
            "state": "MT",
            "postal_code": "594741663",
            "country_code": "US",
            "telephone_number": "406-434-3200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "670 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Shelby",
            "state": "MT",
            "postal_code": "594741663",
            "country_code": "US",
            "telephone_number": "406-966-7040",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "315 W Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Chester",
            "state": "MT",
            "postal_code": "595227801",
            "country_code": "US",
            "telephone_number": "406-759-5181",
            "fax_number": "406-759-5799",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "418 W Monroe Ave",
            "address_purpose": "LOCATION",
            "city": "Chester",
            "state": "MT",
            "postal_code": "595227835",
            "country_code": "US",
            "telephone_number": "406-759-5181",
            "fax_number": "406-759-5105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANGOLD",
        "first_name": "DAVID",
        "middle_name": "E.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MT",
            "license": "323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Logan Health - Shelby",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "640 Park Ave",
            "city": "Shelby",
            "state": "MT",
            "country_code": "US",
            "postal_code": "594741663",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Liberty County Hospital and Nursing Home, Inc",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "315 W Madison Ave",
            "city": "Chester",
            "state": "MT",
            "country_code": "US",
            "postal_code": "595227801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kalispell, MT

Sources for this page

Verify at the official NPI Registry.