Individual provider Active NPI

Bryn Van Hoomissen

  • Anesthesiology Physician
  • Missoula, MT
National Provider Identifier
1457779522
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MED-PHYS-LIC-66778 Issued in MT
Practice address
2825 Stockyard Rd Ste I-200
Missoula, MT 59808-1548
Phone
(406) 728-8420
Fax
(406) 541-8430
NPI assigned
Apr 4, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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 NC
Anesthesiology Physician 207L00000X MED-PHYS-LIC-66778 MT Primary

Addresses

Primary practice location

2825 Stockyard Rd Ste I-200
Missoula, MT 59808-1548

Mailing address

2301 Erwin Rd
Durham, NC 27705-4699
Phone (919) 684-8111

Other practice location 1

2301 Erwin Rd
Durham, NC 27705-4699
Phone (919) 684-8111

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
I20180718002295 MT Practitioner - Anesthesiology 7113274465 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Minnesota Medical School, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Missoula Anesthesiology PCGroup PAC ID 5597669960, 45 clinicians

Practice addresses (Care Compare)

500 W Broadway
St Patrick Hospital
Missoula, MT 59802-4008
Phone (406) 543-7271

Hospital & facility affiliations

  • St. Patrick Hospital Hospital, Missoula, MT, CCN 270014
  • Community Medical Center Hospital, Missoula, MT, CCN 270023

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MED-PHYS-LIC-66778MTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Missoula Anesthesiology, P.C. Anesthesiology CurrentSince Aug 13, 2018 Accepting new patients
Ma Critical Care Services, PC Past Accepting new patients

Locations

2360 Mullan Rd
Missoula, MT 59808
Phone (406) 541-4263

2827 Fort Missoula Rd
Missoula, MT 59804
Phone (406) 327-4202

2825 Stockyard Rd
Ste I-200
Missoula, MT 59808
Phone (406) 728-4100

500 W Broadway St
Missoula, MT 59802
Phone (406) 327-1918

902 N Orange St
Missoula, MT 59802
Phone (406) 327-3300

2833 Fort Missoula Rd
Missoula, MT 59804
Phone (406) 542-6559

Organizations & group practices 2

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 5

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": "1396569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529452800000",
    "number": "1457779522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054699",
            "telephone_number": "919-684-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 STOCKYARD RD STE I-200",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081548",
            "telephone_number": "406-728-8420",
            "fax_number": "406-541-8430"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2301 Erwin Rd",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277054699",
            "country_code": "US",
            "telephone_number": "919-684-8111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN HOOMISSEN",
        "first_name": "BRYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-04",
        "last_updated": "2018-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MT",
            "license": "MED-PHYS-LIC-66778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.