NPIMap

Individual provider Active NPI

Jamie Martin

  • Family Nurse Practitioner
  • Missoula, MT
National Provider Identifier
1538874003
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NUR-APRN-LIC-241285 Issued in MT
Practice address
500 W Broadway St FL 2
Missoula, MT 59802-4008
Phone
(406) 728-2539
NPI assigned
Jan 19, 2023
Last updated
Oct 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X F07240135 MT
Family Nurse Practitioner 363LF0000X NUR-APRN-LIC-241285 MT Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

500 W Broadway St FL 2
Missoula, MT 59802-4008

Mailing address

PO Box 12
Liberty Lake, WA 99019-0012
Phone (406) 728-2539

Other practice location 1

1500 University Dr
Billings, MT 59101-0245
Phone (406) 994-3597

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
I20241008001416 MT Practitioner - Nurse Practitioner 3678004108 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
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 59802-4096
Phone (406) 329-5838

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F07240135MTMDNurse Practitioner
NUR-APRN-LIC-241285MTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt Current Accepting new patients
Providence Health & Services Mt CurrentSince Nov 1, 2024 Accepting new patients
Providence Health & Services Mt Nurse Practitioner CurrentSince Nov 1, 2024 Accepting new patients
Providence Health & Services Mt Past Accepting new patients

Locations

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

500 W Broadway St
Fl 2
Missoula, MT 59802
Phone (406) 728-2539

500 W Broadway St
Ste 320
Missoula, MT 59802
Phone (406) 329-2945

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, 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": "1674086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1538874003",
    "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": "406-728-2539",
            "fax_number": "406-329-5663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST FL 2",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008",
            "telephone_number": "406-728-2539"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 University Dr",
            "address_purpose": "LOCATION",
            "city": "Billings",
            "state": "MT",
            "postal_code": "591010245",
            "country_code": "US",
            "telephone_number": "406-994-3597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "JAMIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-19",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MT",
            "license": "F07240135",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MT",
            "license": "NUR-APRN-LIC-241285",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.