NPIMap

Individual provider Active NPI

Nicholas Alan Mantini

  • Clinical Cardiac Electrophysiology Physician
  • Missoula, MT
National Provider Identifier
1588808646
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
MED-PHYS-LIC-86861 Issued in MT
Practice address
500 W Broadway St Ste 320
Missoula, MT 59802-4003
Phone
(406) 329-5615
Fax
(406) 329-5606
NPI assigned
Apr 20, 2009
Last updated
Jan 15, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology Physician 207RC0001X MED-PHYS-LIC-86861 MT Primary
Electrodiagnostic Medicine Physician 204R00000X MED-PHYS-LIC-86861 MT

Addresses

Primary practice location

500 W Broadway St Ste 320
Missoula, MT 59802-4003

Mailing address

PO Box 31001
Pasadena, CA 91110-4114
Phone (406) 329-5615

Other practice location 1

1364 Clifton Rd NE
Atlanta, GA 30322-1059
Phone (404) 616-6779

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
I20200714000997 MT Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 5193963205 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology), Internal Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians

Practice addresses (Care Compare)

500 W Broadway St
Suite 320
Missoula, MT 59802-4003
Phone (406) 329-5615

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair108

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt Current Accepting new patients
Credena Health LLC CurrentSince May 17, 2021 Accepting new patients
Providence Health & Services Mt CurrentSince Aug 13, 2020 Accepting new patients
Providence Health & Services Mt CurrentSince Aug 13, 2020 Accepting new patients
Providence St Joseph Medical Center CurrentSince May 17, 2021 Accepting new patients
Providence St Joseph Medical Center CurrentSince Dec 22, 2025 Accepting new patients

Locations

1200 Westwood Dr
Hamilton, MT 59840
Phone (406) 363-2211

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

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

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

Organizations & group practices 6

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 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1240185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1588808646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104114",
            "telephone_number": "406-329-5615",
            "fax_number": "406-329-5606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST STE 320",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024003",
            "telephone_number": "406-329-5615",
            "fax_number": "406-329-5606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1364 Clifton Rd NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303221059",
            "country_code": "US",
            "telephone_number": "404-616-6779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANTINI",
        "first_name": "NICHOLAS",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-20",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "MT",
            "license": "MED-PHYS-LIC-86861",
            "primary": true
        },
        {
            "code": "204R00000X",
            "taxonomy_group": "",
            "desc": "Electrodiagnostic Medicine",
            "state": "MT",
            "license": "MED-PHYS-LIC-86861",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.