NPIMap

Individual provider Active NPI

Douglas M. Henry, PA-C

  • Physician Assistant
  • Missoula, MT
National Provider Identifier
1275512071
Registry record updated Nov 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
272 Issued in MT
Practice address
2360 Mullan Rd
Suite C
Missoula, MT 59808-1811
Phone
(406) 721-4436
Fax
(406) 721-6053
NPI assigned
Jan 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 272 MT Primary

Addresses

Primary practice location

2360 Mullan Rd
Suite C
Missoula, MT 59808-1811

Mailing address

2360 Mullan Rd
Suite C
Missoula, MT 59808-1811
Phone (406) 721-4436

Other identifiers 1

IdentifierTypeStateIssuer
000082090MedicaidMT

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
I20100305000316 MT Practitioner - Physician Assistant 2769527449 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Missoula Bone and Joint LLCGroup PAC ID 3870583990, 57 clinicians

Practice addresses (Care Compare)

2360 Mullan Rd
Suite C
Missoula, MT 59808-1811
Phone (406) 721-4436

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.24 of 100Reported as individual
Quality
44.15
Promoting interoperability
100
Improvement activities
40
Cost
100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
272MTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Organizations & group practices 2

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 7

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": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258502400000",
    "number": "1275512071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2360 MULLAN RD",
            "address_2": "SUITE C",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081811",
            "telephone_number": "406-721-4436",
            "fax_number": "406-721-6053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2360 MULLAN RD",
            "address_2": "SUITE C",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081811",
            "telephone_number": "406-721-4436",
            "fax_number": "406-721-6053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "DOUGLAS",
        "middle_name": "M.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-11",
        "last_updated": "2009-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000082090",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.