NPIMap

Individual provider Active NPI

Jason Thomas Anderson, MD

  • Diagnostic Radiology Physician
  • Bozeman, MT
National Provider Identifier
1508201773
Registry record updated Oct 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MED-PHYS-LIC-76665 Issued in MT
Practice address
1648 Ellis St Ste 201
Bozeman, MT 59715-8811
Phone
(406) 587-8631
Fax
(406) 587-1343
NPI assigned
May 1, 2013
Last updated
Oct 8, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 8, 2020

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
Diagnostic Radiology Physician 2085R0202X MED-PHYS-LIC-76665 MT Primary

Addresses

Primary practice location

1648 Ellis St Ste 201
Bozeman, MT 59715-8811

Mailing address

1648 Ellis St Ste 201
Bozeman, MT 59715-8811
Phone (406) 587-8631

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
I20190617003313 MT Practitioner - Diagnostic Radiology 2668737826 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Nevada School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deaconess Intercity Imaging LLCGroup PAC ID 0941238042, 13 clinicians
Intercity Radiology PCGroup PAC ID 9830003847, 14 clinicians

Practice addresses (Care Compare)

905 Highland Blvd
Suite 4100
Bozeman, MT 59715-6901
Phone (406) 556-5200

915 Highland Blvd
Bozeman, MT 59715-6902
Phone (406) 587-8631

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
43.66 of 100Reported as group
Quality
87.31
Improvement activities
0

Merit-based Incentive Payment System (MIPS)

Final score
80.42 of 100Reported as group
Quality
94.62
Improvement activities
0

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MED-PHYS-LIC-76665MTMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Intercity Imaging LLC CurrentSince Jul 1, 2019 Accepting new patients

Locations

1283 N 14th Ave
Ste 202
Bozeman, MT 59715

1648 Ellis St
Ste 201
Bozeman, MT 59715
Phone (406) 556-4649

905 Highland Blvd
Ste 4100
Bozeman, MT 59715
Phone (406) 556-5200

915 Highland Blvd
Bozeman, MT 59715
Phone (406) 414-1720

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1367366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602115200000",
    "number": "1508201773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1648 ELLIS ST STE 201",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597158811",
            "telephone_number": "406-587-8631",
            "fax_number": "406-587-1343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1648 ELLIS ST STE 201",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597158811",
            "telephone_number": "406-587-8631",
            "fax_number": "406-587-1343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JASON",
        "middle_name": "THOMAS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-01",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MT",
            "license": "MED-PHYS-LIC-76665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bozeman, MT

Sources for this page

Verify at the official NPI Registry.