Individual provider Active NPI

Makenna Ann Stavins, MD

  • Internal Medicine Physician
  • Missoula, MT
National Provider Identifier
1427708684
Registry record updated Jul 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MED-PHYS-LIC-148232 Issued in MT
Practice address
500 W Broadway St FL 4
Missoula, MT 59802-4008
Phone
(406) 327-1900
NPI assigned
Mar 28, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X MED-PHYS-LIC-148232 MT Primary

Addresses

Primary practice location

500 W Broadway St FL 4
Missoula, MT 59802-4008

Mailing address

500 W Broadway St FL 4
Missoula, MT 59802-4008

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
I20250723002540 MT Practitioner - Internal Medicine 5991192858 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Washington School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians

Practice addresses (Care Compare)

500 W Broadway St
FL 4
Missoula, MT 59802-4008
Phone (406) 327-1900

Hospital & facility affiliations

  • Partners in Home Care Inc Home health agency, Missoula, MT, CCN 277032
  • St. Patrick Hospital Hospital, Missoula, MT, CCN 270014
  • Community Medical Center Hospital, Missoula, MT, CCN 270023

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MED-PHYS-LIC-148232MTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt Current Accepting new patients
Providence Health & Services Mt Internal Medicine CurrentSince Aug 25, 2025 Accepting new patients
Providence Health & Services Mt CurrentSince Aug 25, 2025 Accepting new patients
Providence Health & Services Mt Past Accepting new patients

Locations

500 W Broadway St
Fl 4
Missoula, MT 59802
Phone (406) 327-1900

500 W Broadway St
Ste 320
Missoula, MT 59802
Phone (406) 329-2945

Interoperability endpoints

  • Direct secure messaging: mstavins3194234@wm.providencedirect.org

Organizations & group practices 4

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 6

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": "1648425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751760000000",
    "number": "1427708684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST FL 4",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST FL 4",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008",
            "telephone_number": "406-327-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAVINS",
        "first_name": "MAKENNA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-28",
        "last_updated": "2025-07-06",
        "certification_date": "2025-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MT",
            "license": "MED-PHYS-LIC-148232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.