NPIMap

Individual provider Active NPI

Jeffrey Haller, MD

  • Otolaryngology Physician
  • Missoula, MT
National Provider Identifier
1194712307
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
9810 Issued in MT
Practice address
700 W Kent Ave
Missoula, MT 59801-6772
Phone
(406) 541-3277
Fax
(406) 541-3950
NPI assigned
Oct 3, 2005
Last updated
Jul 10, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 9810 MT Primary

Addresses

Primary practice location

700 W Kent Ave
Missoula, MT 59801-6772

Mailing address

PO Box 4907
Missoula, MT 59806-4907
Phone (406) 541-3277

Other identifiers 3

IdentifierTypeStateIssuer
35711MedicaidMT
003084200MedicaidID
120178600MedicaidWY

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
I20100917000158 MT Practitioner - Otolaryngology 0840182689 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Washington School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rocky Mountain Ear Nose and Throat Center PCGroup PAC ID 3678472099, 20 clinicians

Practice addresses (Care Compare)

6 13TH Ave E
Polson, MT 59860-5315
Phone (406) 883-5377

700 W Kent Ave
Missoula, MT 59801-6772
Phone (406) 541-3937

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9810MTMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Credena Health LLC CurrentSince Feb 1, 2017 Accepting new patients
Rocky Mountain Ear Nose & Throat Center PC Otolaryngology CurrentSince Aug 1, 2001 Accepting new patients
Marcus Daly Memorial Hospital Corporation Current Accepting new patients
Providence St Joseph Medical Center CurrentSince Feb 1, 2017 Accepting new patients
University Ear Nose and Throat Associates Otolaryngology Past Accepting new patients

Locations

2760 Elizabeth Warren Ave
Ste B
Butte, MT 59701
Phone (406) 792-1250

1200 Westwood Dr
Hamilton, MT 59840
Phone (406) 363-2211

700 W Kent Ave
Missoula, MT 59801
Phone (406) 541-3277

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

Interoperability endpoints

  • Direct secure messaging: jhaller208845@wm.providencedirect.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 8

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": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1194712307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4907",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598064907",
            "telephone_number": "406-541-3277",
            "fax_number": "406-541-3950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W KENT AVE",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598016772",
            "telephone_number": "406-541-3277",
            "fax_number": "406-541-3950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLER",
        "first_name": "JEFFREY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-03",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MT",
            "license": "9810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35711",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003084200",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120178600",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.