Individual provider Active NPI

Jack Tower Branston, MD

  • Emergency Medicine Physician
  • Missoula, MT
National Provider Identifier
1518464643
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MED-PHYS-LIC-96286 Issued in MT
Practice address
500 W Broadway St
Missoula, MT 59802-4008
Phone
(406) 329-5635
Fax
(406) 327-2160
NPI assigned
Apr 5, 2018
Last updated
Nov 11, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 11420196-1205 UT
Emergency Medicine Physician 207P00000X MED-PHYS-LIC-96286 MT Primary

Addresses

Primary practice location

500 W Broadway St
Missoula, MT 59802-4008

Mailing address

PO Box 12
Liberty Lake, WA 99019-0012
Phone (406) 329-5635

Other practice location 1

30 N 1900 E Rm 1C026
Salt Lake City, UT 84132-0001
Phone (801) 581-2272

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jbranston205168@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210422002086 MT Practitioner - Emergency Medicine 9537592852 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Hawaii John a. Burns School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians

Practice addresses (Care Compare)

500 W Broadway St
Missoula, MT 59802-4008
Phone (406) 329-5828

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MED-PHYS-LIC-96286MTMDEmergency Medicine Physician
11420196-1205UTMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt Current Accepting new patients
Providence Health & Services Mt CurrentSince Jun 1, 2021 Accepting new patients
Providence Health & Services Mt CurrentSince Jun 1, 2021 Accepting new patients

Locations

500 W Broadway St
Missoula, MT 59802
Phone (406) 327-1918

500 W Broadway St
Ste 320
Missoula, MT 59802

6 13th Ave E
Polson, MT 59860
Phone (406) 883-5377

Interoperability endpoints

  • Direct secure messaging: jbranston205168@wm.providencedirect.org

Organizations & group practices 3

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 4

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": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1518464643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190012",
            "telephone_number": "406-329-5635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008",
            "telephone_number": "406-329-5635",
            "fax_number": "406-327-2160"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 N 1900 E Rm 1C026",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841320001",
            "country_code": "US",
            "telephone_number": "801-581-2272",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRANSTON",
        "first_name": "JACK",
        "middle_name": "TOWER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-05",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "UT",
            "license": "11420196-1205",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MT",
            "license": "MED-PHYS-LIC-96286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jbranston205168@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 W Broadway St",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.