NPIMap

Individual provider Active NPI

Elizabeth Ryan Jaffe, MD

  • Family Medicine Physician
  • Kalispell, MT
National Provider Identifier
1306809843
Registry record updated Feb 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MED-PHYS-LIC-100641 Issued in MT
Practice address
1287 Burns Way
Kalispell, MT 59901-3109
Phone
(406) 752-8120
Fax
(406) 752-8134
NPI assigned
Apr 7, 2006
Last updated
Feb 19, 2024By the provider in NPPES
Sex
Female
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MED-PHYS-LIC-100641 MT Primary
Family Medicine Physician 207Q00000X 100641 MT

Addresses

Primary practice location

1287 Burns Way
Kalispell, MT 59901-3109

Mailing address

1287 Burns Way Ste 660
Kalispell, MT 59901-3109
Phone (406) 752-8120

Other names 1

  • Elizabeth Ryan Bergemann Other name

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
I20231211000372 MT Practitioner - Family Practice 7911925888 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nevada School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1273 Burns Way
Kalispell, MT 59901-3109
Phone (406) 752-8300

350 Heritage Way
Kalispell, MT 59901-3167

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions12

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
100641MTMDFamily Medicine Physician
MED-PHYS-LIC-100641MTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kalispell Regional Medical Center Inc CurrentSince Sep 26, 2023 Accepting new patients
Kalispell Regional Medical Center, Inc CurrentSince Sep 26, 2023 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Saint Marys Medical Group Inc. Current Accepting new patients
Glacier Regional Pathology, LTD. Current Accepting new patients
Kalispell Regional Medical Center, Inc Past Accepting new patients
Elizabeth R Jaffe MD Prof. Corp Family Medicine PastSince Nov 1, 2008 Accepting new patients

Locations

1801 W Olympic Blvd
#1461
Pasadena, CA 91199

1287 Burns Way
Kalispell, MT 59901
Phone (406) 752-8120

1287 Burns Way
Ste 660
Kalispell, MT 59901

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

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

18653 Wedge Pkwy
Ste 110
Reno, NV 89511
Phone (775) 352-7201

645 N Arlington Ave
Ste 555
Reno, NV 89503
Phone (775) 770-7348

645 N Arlington Ave
Ste 660
Reno, NV 89503
Phone (775) 746-3338

Interoperability endpoints

  • Direct secure messaging: elizabeth.jaffe.p1@direct.smmg.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: krmcmedicalrecords@krhdirect.org

Organizations & group practices 8

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": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708300800000",
    "number": "1306809843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1287 BURNS WAY STE 660",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013109",
            "telephone_number": "406-752-8120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1287 BURNS WAY",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013109",
            "telephone_number": "406-752-8120",
            "fax_number": "406-752-8134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAFFE",
        "first_name": "ELIZABETH",
        "middle_name": "RYAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-07",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "MED-PHYS-LIC-100641",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "100641",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "address_1": "1287 Burns Way",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599013109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "BERGEMANN",
            "middle_name": "RYAN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kalispell, MT

Sources for this page

Verify at the official NPI Registry.