Active NPI
Vincent Bryan River, PH.D.
- Clinical Child & Adolescent Psychologist
- Polson, MT
National Provider Identifier
1497821672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 328
- Practice address
- 1201 Main St
Suite a
Polson, MT 59860-5333 - Phone
- (406) 883-8126
- Fax
- (406) 883-9226
- NPI assigned
- Nov 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 328 | MT | Primary |
| Forensic Psychologist | 103TF0200X | 328 | MT |
Addresses
Primary practice location
1201 Main St
Suite a
Polson, MT 59860-5333
Mailing address
1201 Main St
Suite a
Polson, MT 59860-5333
Phone (406) 883-8126
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 490739 | Medicaid | MT | |
| 51871 | Other | MT | BLUE CROSS BLUE SHIELD |
| 7718 59860 0000 | Other | MT | TRICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 328 | MT | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351641600000",
"number": "1497821672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 MAIN ST",
"address_2": "SUITE A",
"city": "POLSON",
"state": "MT",
"postal_code": "598605333",
"telephone_number": "406-883-8126",
"fax_number": "406-883-9226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 MAIN ST",
"address_2": "SUITE A",
"city": "POLSON",
"state": "MT",
"postal_code": "598605333",
"telephone_number": "406-883-8126",
"fax_number": "406-883-9226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVER",
"first_name": "VINCENT",
"middle_name": "BRYAN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-28",
"last_updated": "2012-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MT",
"license": "328",
"primary": true
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "MT",
"license": "328",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "490739",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "51871",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "7718 59860 0000",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Polson, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.