Individual provider Active NPI

Hallie A Bornstein Banziger, PHD

  • Psychologist
  • Missoula, MT
National Provider Identifier
1326197906
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
MT366 Issued in MT
Practice address
125 Bank Street
Suite 310
Missoula, MT 59802
Phone
(406) 549-7325
Fax
(406) 549-7559
NPI assigned
Jan 10, 2007
Sex
Female
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
Psychologist 103T00000X MT366 MT Primary

Addresses

Primary practice location

125 Bank Street
Suite 310
Missoula, MT 59802

Mailing address

125 Bank Street
Suite 310
Missoula, MT 59802
Phone (406) 549-7325

Other identifiers 2

IdentifierTypeStateIssuer
0492949MedicaidMT
52501OtherMTBLUE CROSS SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050801000765 MT Practitioner - Clinical Psychologist 2163450180 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

935 Highland Blvd
Suite 2200
Bozeman, MT 59715-6915
Phone (406) 219-3311

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT366MTMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hallie Bornstein Banziger PHD LLC CurrentSince Jan 1, 2008 Accepting new patients

Locations

935 Highland Blvd
Ste 2200
Bozeman, MT 59715
Phone (406) 219-3311

125 Bank St
Ste 310
Missoula, MT 59802
Phone (406) 282-4402

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1326197906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 BANK STREET",
            "address_2": "SUITE 310",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59802",
            "telephone_number": "406-549-7325",
            "fax_number": "406-549-7559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 BANK STREET",
            "address_2": "SUITE 310",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59802",
            "telephone_number": "406-549-7325",
            "fax_number": "406-549-7559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORNSTEIN BANZIGER",
        "first_name": "HALLIE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MT",
            "license": "MT366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0492949",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS SHIELD",
            "identifier": "52501",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.