NPIMap

Individual provider Active NPI

Jacquelyn Rose McCleary

  • Physician Assistant
  • Polson, MT
National Provider Identifier
1477324671
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MED-PAC-LIC-145547 Issued in MT
Practice address
106 Ridgewater Dr Ste a
Polson, MT 59860-8977
Phone
(406) 883-3200
Fax
(406) 883-9483
NPI assigned
Jan 16, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MED-PAC-LIC-145547 MT Primary

Addresses

Primary practice location

106 Ridgewater Dr Ste a
Polson, MT 59860-8977

Mailing address

1545 Lakers Way Apt 4
Billings, MT 59106-8556

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krmcmedicalrecords@krhdirect.org Direct 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
I20241028001251 MT Practitioner - Physician Assistant 7214460468 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

350 Heritage Way
Kalispell, MT 59901-3167

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MED-PAC-LIC-145547MTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kalispell Regional Medical Center, Inc CurrentSince Nov 18, 2024 Accepting new patients
Kalispell Regional Medical Center Inc CurrentSince Nov 18, 2024 Accepting new patients
Kalispell Regional Medical Center, Inc Past Accepting new patients

Locations

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

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

106 Ridgewater Dr
Ste A
Polson, MT 59860
Phone (406) 883-3200

Interoperability endpoints

  • Direct secure messaging: krmcmedicalrecords@krhdirect.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 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": "1705363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729209600000",
    "number": "1477324671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 LAKERS WAY APT 4",
            "city": "BILLINGS",
            "state": "MT",
            "postal_code": "591068556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 RIDGEWATER DR STE A",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598608977",
            "telephone_number": "406-883-3200",
            "fax_number": "406-883-9483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLEARY",
        "first_name": "JACQUELYN",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-16",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "MED-PAC-LIC-145547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center, Inc",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "106 Ridgewater Dr Ste A",
            "city": "Polson",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598608977",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Polson, MT

Sources for this page

Verify at the official NPI Registry.