NPIMap

Individual provider Active NPI

Jennifer Rae Doty, P.A.-C

  • Physician Assistant
  • Missoula, MT
National Provider Identifier
1295183994
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
60099 Issued in MT
Practice address
601 W Spruce St Ste J
Missoula, MT 59802-4047
Phone
(406) 327-3350
NPI assigned
Jun 3, 2016
Last updated
Nov 11, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2021

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 60099 MT Primary

Addresses

Primary practice location

601 W Spruce St Ste J
Missoula, MT 59802-4047

Mailing address

601 W Spruce St Ste J
Missoula, MT 59802-4047
Phone (406) 329-4142

Other identifiers 1

IdentifierTypeStateIssuer
1295183994MedicaidMT

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jschuberg204925@wm.providencedirect.org Direct

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
I20171102003230 MT Practitioner - Physician Assistant 1759647035 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians

Practice addresses (Care Compare)

500 W Broadway St
Missoula, MT 59802-4003

601 W Spruce St
Missoula, MT 59802-4047

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60099MTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt CurrentSince Nov 27, 2017 Accepting new patients
Providence Health & Services Mt CurrentSince Nov 27, 2017 Accepting new patients
Providence Health & Services Mt Past Accepting new patients

Locations

500 W Broadway St
Ste 320
Missoula, MT 59802

601 W Spruce St
Ste J
Missoula, MT 59802
Phone (406) 329-2668

Organizations & group practices 4

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1295183994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 W SPRUCE ST STE J",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024047",
            "telephone_number": "406-329-4142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W SPRUCE ST STE J",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024047",
            "telephone_number": "406-327-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOTY",
        "first_name": "JENNIFER",
        "middle_name": "RAE",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-03",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "60099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295183994",
            "state": "MT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jschuberg204925@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "601 W Spruce St Ste J",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.