Clifford Wayne Davis, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

301 Issued in MT

Practice address

805 Sunset Blvd
P O 758
Conrad, MT 59425-1717

Phone

(406) 271-3211

Fax

(406) 271-7661

NPI assigned

May 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1225356868

  CO

  Medicare reassignment Care Compare group
• Emergency Professionals of Colorado, PC

  • Emergency Medicine Physician
  • Loveland, CO
  • NPI 1396496469

  CO

  Medicare reassignment
• True North Health Navigation LLC

  • Emergency Medicine Physician
  • Denver, CO
  • NPI 1740622133

  CO

  Medicare reassignment
• Emergency Professionals of Colorado, PC

  • Emergency Medicine Physician
  • Greeley, CO
  • NPI 1366835415

  Physician Assistant

  NPD
• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1366763260
  NPD
• Bates Family Diversified, LLC

  • Rural Health Clinic/Center
  • Three Forks, MT
  • NPI 1003466822
  NPD (past)
• Great Falls Orthopaedic Associates

  • Specialist
  • Great Falls, MT
  • NPI 1104865120
  NPD (past)
• Logan Health - Conrad

  • Critical Access Hospital
  • Conrad, MT
  • NPI 1467445049
  NPD (past)
• Three Rivers Clinic LLC

  • Rural Health Clinic/Center
  • Three Forks, MT
  • NPI 1851425789
  NPD (past)

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1427000751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3619 5TH AVE N",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594012207",
            "telephone_number": "406-271-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 SUNSET BLVD",
            "address_2": "P O 758",
            "city": "CONRAD",
            "state": "MT",
            "postal_code": "594251717",
            "telephone_number": "406-271-3211",
            "fax_number": "406-271-7661"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3827 N Lafayette St",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802053339",
            "country_code": "US",
            "telephone_number": "303-500-1518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "CLIFFORD",
        "middle_name": "WAYNE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "301",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA0004597",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsie Nicole Brutke
• Cherry Tree Dental PC
• Kelsee Clark, PTA
• Jamie Kay Cole, RPH
• Conrad School District
• Keri Lynn Degroat, L.A.C.
• Eastern Front Counseling LLC
• Farm View Dental PLLC
• Lara Fowler
• Bethanie Nicole Funderburk, DPT

• Physician Assistant in Conrad, MT
• Providers in Conrad, MT by specialty
• Physician Assistant in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.