Individual provider Active NPI

Kristopher Poliakiwski, MD

  • Psychiatry Physician
  • Great Falls, MT
National Provider Identifier
1356864748
Registry record updated Apr 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
107704 Issued in MT
Practice address
1500 10TH Ave S Ste 200
Great Falls, MT 59405-2619
Phone
(406) 866-0350
Fax
(406) 403-0263
NPI assigned
Jul 18, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 107704 MT Primary

Addresses

Primary practice location

1500 10TH Ave S Ste 200
Great Falls, MT 59405-2619

Mailing address

1500 10TH Ave S Ste 200
Great Falls, MT 59405-2619
Phone (406) 866-0350

Other identifiers 1

IdentifierTypeStateIssuer
12083MedicaidND

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
I20220324001340 MT Practitioner - Psychiatry 4789912007 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Green Apple Counseling LLCGroup PAC ID 8527408251, 3 clinicians

Practice addresses (Care Compare)

1500 10TH Ave S
Suite 200
Great Falls, MT 59405-2619
Phone (406) 866-0350

Merit-based Incentive Payment System (MIPS)

Final score
90.98 of 100Reported as apm
Quality
80.39
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
107704MTMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Great Falls Clinic LLC CurrentSince Oct 11, 2023 Accepting new patients
Green Apple Counseling, LLC Psychiatry CurrentSince Mar 1, 2025 Accepting new patients
Benefis Hospitals, Inc. CurrentSince Mar 15, 2022 Accepting new patients
Benefis Hospitals Inc CurrentSince Mar 15, 2022 Accepting new patients

Locations

1500 10th Ave S
Ste 200
Great Falls, MT 59405
Phone (406) 781-9919

1400 29th St S
Great Falls, MT 59405
Phone (406) 442-3570

1101 26th St S
Fl 5
Great Falls, MT 59405
Phone (406) 455-2132

1101 26th St S
Great Falls, MT 59405
Phone (406) 455-4690

500 15th Ave S
Great Falls, MT 59405
Phone (406) 455-2021

1401 25th St S
Great Falls, MT 59405
Phone (406) 455-3650

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25095/brand/1/csg/1/fhir/r4

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.

NPI Registry JSON

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

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744675200000",
    "number": "1356864748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 10TH AVE S STE 200",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594052619",
            "telephone_number": "406-866-0350",
            "fax_number": "406-403-0263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 10TH AVE S STE 200",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594052619",
            "telephone_number": "406-866-0350",
            "fax_number": "406-403-0263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLIAKIWSKI",
        "first_name": "KRISTOPHER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-18",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MT",
            "license": "107704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12083",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Falls, MT

Sources for this page

Verify at the official NPI Registry.