NPIMap

Organization Active NPI

Vitalimd, PC

  • Physical Medicine & Rehabilitation Physician
  • Bozeman, MT
National Provider Identifier
1477071728
Registry record updated Jul 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
11366 Issued in MT
Legal business name
VITALIMD, PC
Practice address
117 East Oak Street
Bozeman, MT 59715
Phone
(406) 595-0852
NPI assigned
Sep 7, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2018

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

Authorized official

Name
Lisa Marie Todd
Title
Owner
Phone
(406) 595-0852

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X 11366 MT Primary

Addresses

Primary practice location

117 East Oak Street
Bozeman, MT 59715

Mailing address

117 East Oak Street
Bozeman, MT 59715
Phone (406) 595-0852

Other practice location 1

777 E Main St Ste 101
Bozeman, MT 59715-3809
Phone (406) 595-0852

Other identifiers 1

IdentifierTypeStateIssuer
8460164MedicaidMT

Other names 1

  • The Joy and Healing Practice, PC Former legal business name

National Provider Directory

National Provider Directory

Locations

117 E Oak St
Bozeman, MT 59715
Phone (406) 585-3701

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1504742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530576000000",
    "number": "1477071728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 EAST OAK STREET",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "59715",
            "telephone_number": "406-595-0852",
            "fax_number": "406-571-7955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 EAST OAK STREET",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "59715",
            "telephone_number": "406-595-0852"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "777 E Main St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Bozeman",
            "state": "MT",
            "postal_code": "597153809",
            "country_code": "US",
            "telephone_number": "406-595-0852",
            "fax_number": "406-595-0852",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VITALIMD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-07",
        "last_updated": "2018-07-03",
        "status": "A",
        "authorized_official_last_name": "TODD",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-595-0852"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MT",
            "license": "11366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8460164",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Joy and Healing Practice, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "The Joy and Healing Practice, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bozeman, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.