Individual provider Active NPI

Andrew R. Tegeder, MD

  • Dermatology Physician
  • Missoula, MT
National Provider Identifier
1376835769
Registry record updated Jun 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
41724 Issued in MT
Practice address
2835 Fort Missoula Rd BLDG 3
Missoula, MT 59804-7423
Phone
(406) 721-5600
Fax
(406) 329-7192
NPI assigned
May 4, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 41724 MT Primary

Addresses

Primary practice location

2835 Fort Missoula Rd BLDG 3
Missoula, MT 59804-7423

Mailing address

PO Box 7609
Missoula, MT 59807-7609
Phone (406) 721-5600

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ategeder534462@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
I20150710001940 MT Practitioner - Dermatology 4688986193 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Washington School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Western Montana Clinic PCGroup PAC ID 2466365002, 44 clinicians

Practice addresses (Care Compare)

500 W Broadway St
Missoula, MT 59802-4008
Phone (406) 721-5600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.1 of 100Reported as group
Quality
86.66
Promoting interoperability
77
Improvement activities
40
Cost
72.83

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision41
Removal of skin lesions1750
Removal or shaving of skin growth1-10
Skin biopsy602

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41724MTMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Western Montana Clinic PC CurrentSince Aug 1, 2015 Accepting new patients
Western Montana Clinic PC Current Accepting new patients

Locations

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

2835 Fort Missoula Rd
Bldg 3
Missoula, MT 59804

Organizations & group practices 2

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 1

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": "1304467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1376835769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7609",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598077609",
            "telephone_number": "406-721-5600",
            "fax_number": "406-721-3907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2835 FORT MISSOULA RD BLDG 3",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598047423",
            "telephone_number": "406-721-5600",
            "fax_number": "406-329-7192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEGEDER",
        "first_name": "ANDREW",
        "middle_name": "R.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-04",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MT",
            "license": "41724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ategeder534462@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2835 Fort Missoula Rd Bldg 3",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598047423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.