NPIMap

Individual provider Active NPI

Jose C De Souza, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Kalispell, MT
National Provider Identifier
1275534158
Registry record updated Feb 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
8767 Issued in MT
Practice address
430 Windward Way Ste 100
Kalispell, MT 59901-2619
Phone
(406) 751-5364
Fax
(406) 751-5367
NPI assigned
Aug 2, 2005
Last updated
Feb 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 8767 MT Primary

Addresses

Primary practice location

430 Windward Way Ste 100
Kalispell, MT 59901-2619

Mailing address

430 Windward Way Ste 100
Kalispell, MT 59901-2619
Phone (406) 751-5364

Other identifiers 2

IdentifierTypeStateIssuer
1275534158MedicaidMT
1275534158OtherMTBCBS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krmcmedicalrecords@krhdirect.org Kalispell Regional Medical Center 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
I20050112000812 MT Practitioner - Endocrinology 8921057324 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

310 Sunnyview LN
Kalispell, MT 59901-3129
Phone (406) 751-6725

320 Sunnyview LN
Kalispell, MT 59901-3129
Phone (406) 756-3526

350 Heritage Way
Kalispell, MT 59901-3167

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8767MTMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kalispell Regional Medical Center, Inc CurrentSince May 10, 2010 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Kalispell Regional Medical Center Inc CurrentSince May 10, 2010 Accepting new patients
Glacier Regional Pathology, LTD. Current Accepting new patients
Kalispell Regional Medical Center, Inc Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

310 Sunnyview Ln
Kalispell, MT 59901
Phone (406) 751-5310

310 Sunnyview Ln
Ofc Of
Kalispell, MT 59901
Phone (406) 758-7036

350 Heritage Way
Ste 2100
Kalispell, MT 59901
Phone (406) 257-8992

430 Windward Way
Ste 100
Kalispell, MT 59901
Phone (406) 751-5364

Interoperability endpoints

  • Direct secure messaging: krmcmedicalrecords@krhdirect.org

Organizations & group practices 7

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": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708300800000",
    "number": "1275534158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 WINDWARD WAY STE 100",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599012619",
            "telephone_number": "406-751-5364",
            "fax_number": "406-751-5367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 WINDWARD WAY STE 100",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599012619",
            "telephone_number": "406-751-5364",
            "fax_number": "406-751-5367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE SOUZA",
        "first_name": "JOSE",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MT",
            "license": "8767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275534158",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1275534158",
            "state": "MT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "address_1": "430 Windward Way Ste 100",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599012619",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kalispell, MT

Sources for this page

Verify at the official NPI Registry.