NPIMap

Organization Active NPI

Ravalli Family Medicine, LLC

  • Family Medicine Physician
  • Hamilton, MT
National Provider Identifier
1346326824
Registry record updated Aug 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RAVALLI FAMILY MEDICINE, LLC
Practice address
411 W Main Street
Hamilton, MT 59840-2470
Phone
(406) 363-5104
Fax
(406) 363-2894
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2014

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

Authorized official

Name
Kathleen A. Harder-Bronwer, M.D.
Title
Owner
Phone
(406) 363-5104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

411 W Main Street
Hamilton, MT 59840-2470

Mailing address

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

Other names 1

  • Ravalli Family Medicine Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040210000950 MT Part B Supplier - Clinic/Group Practice 3072407196 Receives reassigned benefits from 4 practitioners
Practice locations: Hamilton, MT
O20100824000056 MT Part A Provider - Rural Health Clinic 3072407196 Practice locations: Hamilton, MT

Rural health clinic certification: CCN 273829

Legal name
RAVALLI FAMILY MEDICINE LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 1, 2011
Last certification
Sep 3, 2025
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jan 1, 2004 in MT
Enrollment address
411 W Main St
Hamilton, MT 59840-2470

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
27D1020200Ravalli Family Medicine LLC411 West Main Street, Hamilton, MT 59840Provider-performed microscopyDec 14, 2027

National Provider Directory

National Provider Directory

Locations

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

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lawrence D Brouwer Individual 5% Or Greater Direct Ownership InterestMD & Owner Jan 1, 2004 50%
W-2 Managing EmployeeMD & Owner Jan 1, 2004 50%
Kathleen a Harder-Brouwer Individual 5% Or Greater Direct Ownership InterestMD & Owner Jan 1, 2004 50%
W-2 Managing EmployeeMD & Owner Jan 1, 2004 50%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408320000000",
    "number": "1346326824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 W. MAIN STREET",
            "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 STREET",
            "city": "HAMILTON",
            "state": "MT",
            "postal_code": "598402470",
            "telephone_number": "406-363-5104",
            "fax_number": "406-363-2894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAVALLI FAMILY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2014-08-18",
        "status": "A",
        "authorized_official_last_name": "HARDER-BRONWER",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-363-5104",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ravalli Family Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hamilton, MT

Sources for this page

Verify at the official NPI Registry.