Cody Brown, PA-C
Individual provider Active NPI Physician Assistant · Polson, MT
NPI 1598837239 · NPPES record last updated Apr 27, 2021
Key facts
- NPI
- 1598837239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 276 (MT)
- Practice address
- 6 13TH Ave E
Polson, MT 59860-5315 - Phone
- (406) 883-8432
- Fax
- (406) 883-8255
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Providence St Joseph Medical Center
Practice addresses (Care Compare)
6 13TH Ave E
Polson, MT 59860-5315
Phone (406) 883-5377
Hospital & facility affiliations
- Providence St Joseph Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050823000333 | MT | Practitioner - Physician Assistant | 5991736605 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Credena Health LLC | Current |
Accepting new patients | |
| Providence St Joseph Medical Center | Current |
Accepting new patients | |
| Vibrant Sound Works, Inc | Past | Accepting new patients |
Locations
110 Kruger Rd
Plains, MT 59859
Phone (406) 826-3601
6 13th Ave E
Polson, MT 59860
Phone (406) 883-5377
63351 US Highway 93
Ronan, MT 59864
Phone (406) 676-5680
Interoperability endpoints
- cbrown210444@wm.providencedirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 276 | MT | Yes |
Addresses
Primary practice location
6 13TH Ave E
Polson, MT 59860-5315
Mailing address
6 13TH Ave E
Polson, MT 59860-5315
Phone (406) 883-8432
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4306202 | Medicaid | MT |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cbrown210444@wm.providencedirect.org | Direct |
Other providers in Polson, MT
- Louis Conrad Brenner
- April Brewer
- Brian O Baird, OD
- Darren Brockie
- Clayton Irwin Brovold
- Elizabeth Gwynn Brown
- Joanna Browning
- Sabrina Dawn Bual
- Molly Buchanan
- David W Bull
All providers in Polson, MT · Physician Assistant in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.