Brian Robert Chisdak, MD, DMD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

9512 Issued in MT

Practice address

1994 Stadium Dr.
Bozeman, MT 59715

Phone

(406) 587-0767

Fax

(406) 587-2120

NPI assigned

May 3, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2014 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Frances Mahon Deaconess Hospital

  • Critical Access Hospital
  • Glasgow, MT
  • NPI 1689685323

  Oral & Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457573727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1994 STADIUM DR.",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "59715",
            "telephone_number": "406-587-0767",
            "fax_number": "406-587-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1994 STADIUM DR.",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "59715",
            "telephone_number": "406-587-0767",
            "fax_number": "406-587-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHISDAK",
        "first_name": "BRIAN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "MD, DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MT",
            "license": "9512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Childress, ATC
• Chelsea Childs, PHARMD
• Shannon Aileen Childs, M.S CCC-SLP
• Chilren'S Dental Health Center P.C.
• Ronald Chin, MD
• Jami Lorene Chisdak, MD
• Jennifer Chiu, MS, ATC
• Jennifer A Chrisman, LCPC
• Anja Christensen, RN
• Christian E. Appel, PC

• Oral & Maxillofacial Surgery (D.M.D.) in Bozeman, MT
• Providers in Bozeman, MT by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.