Active NPI
Wally Jean, MD
- General Practice Physician
- Poplar, MT
National Provider Identifier
1346654167
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 19005
- Practice address
- 107 H St W
Poplar, MT 59255 - Phone
- (406) 768-3491
- NPI assigned
- Jun 19, 2014
- Last updated
- Dec 31, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 19005 | PR | Primary |
Addresses
Primary practice location
107 H St W
Poplar, MT 59255
Mailing address
P.O. Box 1582
Poplar, MT 59255
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19005 | PR | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| U S Health Dept of Health & Human Services | Current | Accepting new patients | |
| Mescalero Indian Hospital | Current | Accepting new patients | |
| US Health Dept of Health & Human Services | Current | Accepting new patients | |
| Frances Mahon Deaconess Hospital | Past | Accepting new patients |
Locations
669 Agency Main St
Harlem, MT 59526
Phone (406) 353-3100
107 H St
Poplar, MT 59255
Phone (406) 738-3491
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451520000000",
"number": "1346654167",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 1582",
"city": "POPLAR",
"state": "MT",
"postal_code": "59255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 H ST W",
"city": "POPLAR",
"state": "MT",
"postal_code": "59255",
"telephone_number": "406-768-3491"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEAN",
"first_name": "WALLY",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-19",
"last_updated": "2015-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "PR",
"license": "19005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poplar, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.