NPIMap

Individual provider Active NPI

Douglas Nelson, M.D.

  • Internal Medicine Physician
  • Kalispell, MT
National Provider Identifier
1427091065
Registry record updated Apr 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
7105 Issued in MT
Practice address
1287 Burns Way
Kalispell, MT 59901-3109
Phone
(406) 752-8120
Fax
(406) 752-8134
NPI assigned
Jun 13, 2006
Last updated
Apr 19, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 7105 MT
Internal Medicine Physician 207R00000X 7105 MT Primary

Addresses

Primary practice location

1287 Burns Way
Kalispell, MT 59901-3109

Mailing address

1287 Burns Way
Kalispell, MT 59901-3109
Phone (406) 752-8120

Other identifiers 2

IdentifierTypeStateIssuer
1427091065OtherMTBCBS
1427091065MedicaidMT

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krmcmedicalrecords@krhdirect.org Kalispell Regional Medical Center Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100512001039 MT Practitioner - Internal MedicinePractitioner - Family PracticePractitioner - Pediatric Medicine 9830002179

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of North Carolina at Chapel Hill School of Medicine, 1991
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

310 Sunnyview LN
Kalispell, MT 59901-3129

310 Sunnyview LN
Kalispell, MT 59901-3199

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Kalispell Regional Medical Center, Inc CurrentSince Oct 1, 2010 Accepting new patients
Kalispell Regional Med Center Inc CurrentSince Oct 1, 2010 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Glacier Regional Pathology, LTD. Current Accepting new patients

Locations

1287 Burns Way
Kalispell, MT 59901
Phone (406) 752-8120

200 Commons Way
Ste A
Kalispell, MT 59901
Phone (406) 257-8979

310 Sunnyview Ln
Kalispell, MT 59901
Phone (406) 751-5310

350 Heritage Way
Ste 2100
Kalispell, MT 59901
Phone (406) 257-8992

75 Claremont St
Ste H
Kalispell, MT 59901
Phone (406) 752-7406

Interoperability endpoints

  • Direct secure messaging: krmcmedicalrecords@krhdirect.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Immanuel Skilled Care CenterKalispell, MT, CCN 275129 Skilled nursing facility Managing Control - Governing Body
Trustee of the SNF		 Oct 1, 2021
Oct 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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.

Hospital & facility affiliations 8

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": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618790400000",
    "number": "1427091065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1287 BURNS WAY",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013109",
            "telephone_number": "406-752-8120",
            "fax_number": "406-752-8134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1287 BURNS WAY",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013109",
            "telephone_number": "406-752-8120",
            "fax_number": "406-752-8134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "DOUGLAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MT",
            "license": "7105",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MT",
            "license": "7105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1427091065",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1427091065",
            "state": "MT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "address_1": "1287 Burns Way",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599013109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kalispell, MT

Sources for this page

Verify at the official NPI Registry.