NPIMap

Organization Active NPI

Fallon Medical Complex Inc

Doing business as dba Community Clinic

  • Critical Access Hospital Clinic/Center
  • Baker, MT
National Provider Identifier
1386700763
Registry record updated Oct 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access Hospital Clinic/CenterTaxonomy code 261QC0050X
License
10662 Issued in MT
Legal business name
FALLON MEDICAL COMPLEX INC
Doing business as
dba Community Clinic
Practice address
202 South 4TH Street West
Baker, MT 59313-1119
Phone
(406) 778-2833
Fax
(406) 778-5155
NPI assigned
Dec 29, 2006
Last updated
Oct 9, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
FALLON MEDICAL COMPLEX INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 9, 2007

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

Authorized official

Name
Selena R Nelson
Title
Cfo
Phone
(406) 778-5103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital Clinic/Center 261QC0050X 10662 MT Primary

Addresses

Primary practice location

202 South 4TH Street West
Baker, MT 59313-1119

Mailing address

PO Box 820
Baker, MT 59313-0820
Phone (406) 778-2833

Other names 1

  • dba Community Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040614000391 MT Part B Supplier - Clinic/Group Practice 0941119499 Receives reassigned benefits from 20 practitioners
1 other NPI on this enrollment
Practice locations: Baker, MT; Wibaux, MT

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Fallon Medical Complex

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191888000000",
    "number": "1386700763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 820",
            "city": "BAKER",
            "state": "MT",
            "postal_code": "593130820",
            "telephone_number": "406-778-2833",
            "fax_number": "406-778-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 SOUTH 4TH STREET WEST",
            "city": "BAKER",
            "state": "MT",
            "postal_code": "593131119",
            "telephone_number": "406-778-2833",
            "fax_number": "406-778-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALLON MEDICAL COMPLEX INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FALLON MEDICAL COMPLEX INC",
        "enumeration_date": "2006-12-29",
        "last_updated": "2007-10-09",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "SELENA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "406-778-5103"
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "MT",
            "license": "10662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baker, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.