Individual provider Active NPI

Matthew Randall Fleming, PA-C

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Missoula, MT
National Provider Identifier
1427689983
Registry record updated Feb 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
MED-PAC-LIC-81054 Issued in MT
Practice address
500 W Broadway St Ste 320
Missoula, MT 59802-4003
Phone
(406) 329-5615
NPI assigned
Feb 3, 2020
Last updated
Feb 3, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X MED-PAC-LIC-81054 MT Primary

Addresses

Primary practice location

500 W Broadway St Ste 320
Missoula, MT 59802-4003

Mailing address

1227 1/2 Mordecai Dr
Raleigh, NC 27604-1342
Phone (919) 417-5445

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200326000895 MT Practitioner - Physician Assistant 0648609651 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians

Practice addresses (Care Compare)

500 W Broadway St
Missoula, MT 59802-4003

500 W Broadway St
Missoula, MT 59802-4096

500 W Broadway St 3Rd FL
Missoula, MT 59802-4096

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt CurrentSince Mar 16, 2020 Accepting new patients
Providence Health & Services Mt CurrentSince Mar 16, 2020 Accepting new patients

Locations

500 W Broadway St
Ste 320
Missoula, MT 59802

Organizations & group practices 3

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 4

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": "1580688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580688000000",
    "number": "1427689983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1227 1/2 MORDECAI DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276041342",
            "telephone_number": "919-417-5445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST STE 320",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024003",
            "telephone_number": "406-329-5615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLEMING",
        "first_name": "MATTHEW",
        "middle_name": "RANDALL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-03",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MT",
            "license": "MED-PAC-LIC-81054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.