NPIMap

Individual provider Active NPI

Gabriel P Edwards, MD

  • Vascular & Interventional Radiology Physician
  • Bozeman, MT
National Provider Identifier
1578821963
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
MED-PHYS-LIC-129822 Issued in MT
Practice address
1648 Ellis St Ste 201
Bozeman, MT 59715-8811
Phone
(406) 587-8631
Fax
(406) 587-1343
NPI assigned
Apr 24, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X 13480A WY
Diagnostic Radiology Physician 2085R0202X MED-PHYS-LIC-129822 MT
Vascular & Interventional Radiology Physician 2085R0204X DR.0065827 CO
Vascular & Interventional Radiology Physician 2085R0204X 33359 NE
Vascular & Interventional Radiology Physician 2085R0204X MED-PHYS-LIC-129822 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

Other practice location 1

1024 S LeMay Ave
Fort Collins, CO 80524-3929
Phone (970) 495-7000

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
I20231220002854 MT Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 2860765534 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional RadiologyAlso: Diagnostic Radiology
Education
University of Nevada School of Medicine, 2012
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)

875 S Cottonwood Rd
Suite 150
Bozeman, MT 59718-4208
Phone 40658786311003

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

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0065827COMDVascular & Interventional Radiology Physician
MED-PHYS-LIC-129822MTMDVascular & Interventional Radiology Physician
33359NEMDVascular & Interventional Radiology Physician
13480AWYMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Intercity Imaging LLC CurrentSince Jan 1, 2024 Accepting new patients
Eastern Radiological Associates PC Diagnostic Radiology CurrentSince Jun 16, 2024 Accepting new patients
Yampa Valley Medical Center Past Accepting new patients

Locations

2900 12th Ave N
Ste 4E
Billings, MT 59101
Phone (406) 245-6378

1233 N 30th St
Billings, MT 59101
Phone (406) 237-3850

875 S Cottonwood Rd
Ste 150
Bozeman, MT 59718
Phone (406) 414-3800

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

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

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

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 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": "1335225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1578821963",
    "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": [
        {
            "address_1": "1024 S LeMay Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805243929",
            "country_code": "US",
            "telephone_number": "970-495-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "GABRIEL",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-24",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "WY",
            "license": "13480A",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MT",
            "license": "MED-PHYS-LIC-129822",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "CO",
            "license": "DR.0065827",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NE",
            "license": "33359",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MT",
            "license": "MED-PHYS-LIC-129822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bozeman, MT

Sources for this page

Verify at the official NPI Registry.