NPIMap

Individual provider Active NPI

John Mark Tollerson, DO

  • Family Medicine Physician
  • Kalispell, MT
National Provider Identifier
1467446773
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11207 Issued in MT
Practice address
160 Heritage Way Ste 202
Kalispell, MT 59901-3127
Phone
(406) 752-8433
Fax
(406) 756-6768
NPI assigned
Sep 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OP00002022 WA
Family Medicine Physician 207Q00000X 11207 MT Primary

Addresses

Primary practice location

160 Heritage Way Ste 202
Kalispell, MT 59901-3127

Mailing address

160 Heritage Way Ste 202
Kalispell, MT 59901-3127
Phone (406) 752-8433

Other practice location 1

809 Sunset Blvd
Conrad, MT 59425-1799
Phone (406) 271-3211

Other practice location 2

805 Sunset Blvd
Conrad, MT 59425-1717
Phone (406) 271-3211

Other practice location 3

640 Park Ave
Shelby, MT 59474-1663
Phone (406) 434-3205

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
I20070906000601 MT Practitioner - Family Practice 9537194691 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

160 Heritage Way
Kalispell, MT 59901-3127

350 Heritage Way
Kalispell, MT 59901-3167

Hospital & facility affiliations

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 Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
11207MTMDFamily Medicine Physician
OP00002022WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Logan Health - Conrad CurrentSince Oct 1, 2023 Accepting new patients
Logan Health - Conrad CurrentSince Jan 1, 2025 Accepting new patients
Northern Rockies Medical Center, Inc. CurrentSince May 1, 2021 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Kalispell Regional Medical Center, Inc CurrentSince Aug 13, 2007 Accepting new patients
Northern Rockies Medical Center, Inc. CurrentSince May 1, 2021 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Logan Health - Shelby CurrentSince Oct 1, 2023 Accepting new patients
Glacier Regional Pathology, LTD. Current Accepting new patients
Kalispell Regional Medical Center Inc CurrentSince Aug 13, 2007 Accepting new patients
Logan Health - Conrad CurrentSince Oct 1, 2023 Accepting new patients
Logan Health - Shelby CurrentSince Oct 1, 2023 Accepting new patients
Kalispell Regional Medical Center, Inc Past Accepting new patients

Locations

809 Sunset Blvd
Conrad, MT 59425
Phone (406) 271-3211

805 Sunset Blvd
Conrad, MT 59425
Phone (406) 271-3211

802 2nd St SE
Cut Bank, MT 59427
Phone (406) 873-2251

160 Heritage Way
Ste 202
Kalispell, MT 59901
Phone (406) 752-8433

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

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

640 Park Ave
Shelby, MT 59474
Phone (406) 434-3200

Interoperability endpoints

  • Direct secure messaging: krmcmedicalrecords@krhdirect.org

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 9

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": "1125532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1467446773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 HERITAGE WAY STE 202",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013127",
            "telephone_number": "406-752-8433",
            "fax_number": "406-756-6768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 HERITAGE WAY STE 202",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013127",
            "telephone_number": "406-752-8433",
            "fax_number": "406-756-6768"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "809 Sunset Blvd",
            "address_purpose": "LOCATION",
            "city": "Conrad",
            "state": "MT",
            "postal_code": "594251799",
            "country_code": "US",
            "telephone_number": "406-271-3211",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "805 Sunset Blvd",
            "address_purpose": "LOCATION",
            "city": "Conrad",
            "state": "MT",
            "postal_code": "594251717",
            "country_code": "US",
            "telephone_number": "406-271-3211",
            "fax_number": "406-271-7661",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "640 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Shelby",
            "state": "MT",
            "postal_code": "594741663",
            "country_code": "US",
            "telephone_number": "406-434-3205",
            "fax_number": "406-434-3526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOLLERSON",
        "first_name": "JOHN",
        "middle_name": "MARK",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-01",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP00002022",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "11207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "address_1": "160 Heritage Way Ste 202",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599013127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kalispell, MT

Sources for this page

Verify at the official NPI Registry.