NPIMap

Individual provider Active NPI

Lawrence Dale Brouwer, MD

  • Family Medicine Physician
  • Hamilton, MT
National Provider Identifier
1306922885
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9684 Issued in MT
Practice address
411 W Main St
Hamilton, MT 59840-2470
Phone
(406) 363-5104
Fax
(406) 363-2894
NPI assigned
Oct 27, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9684 MT Primary

Addresses

Primary practice location

411 W Main St
Hamilton, MT 59840-2470

Mailing address

411 W Main St
Hamilton, MT 59840-2470
Phone (406) 363-5104

Other identifiers 2

IdentifierTypeStateIssuer
0069134MedicaidMT
A002OtherMTTRICARE

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
I20040217000168 MT Practitioner - Family Practice 0143114264 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ravalli Family Medicine LLCGroup PAC ID 3072407196, 4 clinicians

Practice addresses (Care Compare)

1200 Westwood Dr
Hamilton, MT 59840-2345

1270 Westwood Dr
Suite 2
Hamilton, MT 59840-2345
Phone (406) 375-4758

411 W Main St
Hamilton, MT 59840-2470
Phone (406) 363-5104

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9684MTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marcus Daly Memorial Hospital Corporation CurrentSince Jun 26, 2009 Accepting new patients
Ravalli Family Medicine, LLC Family Medicine CurrentSince Sep 26, 2003 Accepting new patients
Marcus Daly Memorial Hospital Corporation Current Accepting new patients
Discovery Care Centre, LLC PastSince Oct 1, 2012 Accepting new patients

Locations

1170 Westwood Dr
Ste A
Hamilton, MT 59840
Phone (406) 363-5104

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

1224 W Main St
Hamilton, MT 59840
Phone (406) 375-4823

411 W Main St
Hamilton, MT 59840
Phone (406) 363-5104

3975 US Highway 93 N
Stevensville, MT 59870
Phone (406) 375-4824

715 Main St
Ste A
Stevensville, MT 59870
Phone (406) 777-5522

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Discovery Care CentreHamilton, MT, CCN 275135 Skilled nursing facility Contracted Managing Employee Oct 1, 2012
Bitterroot Health-CorvallisCorvallis, MT, CCN 273418 Rural health clinic Corporate Director May 23, 2018
Ravalli Family Medicine LLCHamilton, MT, CCN 273829 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
W-2 Managing Employee (50%)		 Jan 1, 2004
Jan 1, 2004
Bitterroot Health-VictorVictor, MT, CCN 273429 Rural health clinic Corporate Director May 1, 2018
Bitterroot Health - Darby Scripps ClinicDarby, MT, CCN 273430 Rural health clinic Corporate Director May 1, 2018

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 6

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": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306922885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 W MAIN ST",
            "city": "HAMILTON",
            "state": "MT",
            "postal_code": "598402470",
            "telephone_number": "406-363-5104",
            "fax_number": "406-363-2894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 W MAIN ST",
            "city": "HAMILTON",
            "state": "MT",
            "postal_code": "598402470",
            "telephone_number": "406-363-5104",
            "fax_number": "406-363-2894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUWER",
        "first_name": "LAWRENCE",
        "middle_name": "DALE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "9684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0069134",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "A002",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamilton, MT

Sources for this page

Verify at the official NPI Registry.