Individual provider Active NPI

John Bradley Pickhardt, MD

  • Surgery Physician
  • Missoula, MT
National Provider Identifier
1346283629
Registry record updated Nov 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
6635 Issued in MT
Practice address
500 W Broadway
Missoula, MT 59802-4008
Phone
(406) 542-7525
Fax
(406) 829-0661
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 6635 MT Primary

Addresses

Primary practice location

500 W Broadway
Missoula, MT 59802-4008

Mailing address

PO Box 7817
Missoula, MT 59807-7817
Phone (406) 542-7525

Other practice location 1

6 13th Ave E
Polson, MT 59860-5315
Phone (406) 883-5680

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address jpickhardt140803@wm.providencedirect.org Direct
Direct Messaging Address jpickhardt140803@wm.providencedirect.org Direct
Direct Messaging Address jpickhardt140803@wm.providencedirect.org Direct

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031120000817 MT Practitioner - General Surgery 2567366651 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Arkansas College of Medicine, 1985
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)

500 W Broadway St
Missoula, MT 59802-4003

500 W Broadway St
Missoula, MT 59802-4008

500 W Broadway St
Missoula, MT 59802-4096

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

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Mastectomy64
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6635MTMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt CurrentSince Mar 1, 2002 Accepting new patients
Providence Health & Services Mt CurrentSince Mar 1, 2002 Accepting new patients
Providence Health & Services Mt Current Accepting new patients
Providence Health & Services Mt Past Accepting new patients

Locations

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

500 W Broadway St
Fl 5
Missoula, MT 59802
Phone (406) 329-5866

2819 Great Northern Loop
Ste 200
Missoula, MT 59808
Phone (406) 542-7525

500 W Broadway St
Ste 320
Missoula, MT 59802
Phone (406) 329-2945

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

Interoperability endpoints

  • Direct secure messaging: jpickhardt140803@wm.providencedirect.org

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636416000000",
    "number": "1346283629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7817",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598077817",
            "telephone_number": "406-542-7525",
            "fax_number": "406-829-0661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008",
            "telephone_number": "406-542-7525",
            "fax_number": "406-829-0661"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6 13th Ave E",
            "address_purpose": "LOCATION",
            "city": "Polson",
            "state": "MT",
            "postal_code": "598605315",
            "country_code": "US",
            "telephone_number": "406-883-5680",
            "fax_number": "406-883-8910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PICKHARDT",
        "first_name": "JOHN",
        "middle_name": "BRADLEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MT",
            "license": "6635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpickhardt140803@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "6 13th Ave E",
            "city": "Polson",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598605315",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpickhardt140803@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 W Broadway",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpickhardt140803@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 W Broadway",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.