NPIMap

Individual provider Active NPI

Bradley D Berry, MD

  • Cardiovascular Disease Physician
  • Missoula, MT
National Provider Identifier
1326083023
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
10148 Issued in MT
Practice address
500 W Broadway St
Suite 320
Missoula, MT 59802-4003
Phone
(406) 329-5615
Fax
(406) 329-5606
NPI assigned
Jun 17, 2006
Last updated
Apr 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 10148 MT Primary

Addresses

Primary practice location

500 W Broadway St
Suite 320
Missoula, MT 59802-4003

Mailing address

500 W Broadway St
Suite 320
Missoula, MT 59802-4003
Phone (406) 329-5615

Other identifiers 1

IdentifierTypeStateIssuer
0049556MedicaidMT

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bberry132473@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
I20050510000653 MT Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 8820038789 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
University of Minnesota Medical School, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians

Practice addresses (Care Compare)

1102 E Commercial Ave
Anaconda, MT 59711-2718
Phone (406) 329-5615

1200 Westwood Dr
Hamilton, MT 59840-2345
Phone (406) 363-2211

500 W Broadway St
Missoula, MT 59802-4003

500 W Broadway St
Missoula, MT 59802-4096

500 W Broadway St
Suite 320
Missoula, MT 59802-4031
Phone (406) 329-5615

500 W Broadway St 3Rd FL
Missoula, MT 59802-4096

6 13TH Ave E
Polson, MT 59860-5315
Phone (406) 883-5377

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt Current Accepting new patients
Credena Health LLC CurrentSince Jul 2, 2018 Accepting new patients
Providence Health & Services Mt Cardiovascular Disease CurrentSince Sep 3, 2002 Accepting new patients
Providence St Joseph Medical Center CurrentSince Jul 2, 2018 Accepting new patients
Providence Health & Services Mt CurrentSince Sep 3, 2002 Accepting new patients
Western Montana Clinic PC Current Accepting new patients
Western Montana Clinic PC Current Accepting new patients
Providence Health & Services Mt Cardiovascular Disease Past Accepting new patients

Locations

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

500 W Broadway St
Missoula, MT 59802
Phone (406) 327-1918

500 W Broadway St
Ste 320
Missoula, MT 59802

6 13th Ave E
Polson, MT 59860
Phone (406) 883-5377

63351 US Highway 93
Ronan, MT 59864
Phone (406) 676-5680

Interoperability endpoints

  • Direct secure messaging: bberry132473@wm.providencedirect.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 9

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": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1326083023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST",
            "address_2": "SUITE 320",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024003",
            "telephone_number": "406-329-5615",
            "fax_number": "406-329-5606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST",
            "address_2": "SUITE 320",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024003",
            "telephone_number": "406-329-5615",
            "fax_number": "406-329-5606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "BRADLEY",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-17",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MT",
            "license": "10148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0049556",
            "state": "MT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bberry132473@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 W Broadway St",
            "address_2": "Suite 320",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.