NPIMap

Individual provider Active NPI

Logan Matthew McDaneld, MD

  • Vascular Neurology Physician
  • Grand Junction, CO
National Provider Identifier
1619001633
Registry record updated Aug 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Neurology PhysicianTaxonomy code 2084V0102X
License
DR.0050420 Issued in CO
Practice address
750 Wellington Ave
Ste 3C
Grand Junction, CO 81501-6132
Phone
(970) 298-3150
Fax
(970) 298-3151
NPI assigned
Mar 14, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X LL15994 OR
Neurology Physician 2084N0400X DR.0050420 CO
Vascular Neurology Physician 2084V0102X DR.0050420 CO Primary

Addresses

Primary practice location

750 Wellington Ave
Ste 3C
Grand Junction, CO 81501-6132

Mailing address

2635 N 7TH St
Grand Junction, CO 81501-8209
Phone (970) 298-2273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20120207000828 CO Practitioner - Neurology 6608033352 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Colorado School of Medicine, Denver, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Intermountain Medical Group Grand Junction, LLCGroup PAC ID 3779707856, 297 clinicians

Practice addresses (Care Compare)

1050 Wellington Ave
Imh Wellington Lung and Sleep Clinic
Grand Junction, CO 81501-8121
Phone (970) 298-5864

2635 N 7TH St
Grand Junction, CO 81501-8209

Hospital & facility affiliations

  • Intermountain Health St. Mary'S Regional Hospital Hospital, Grand Junction, CO, CCN 060023
  • Mercy Regional Medical Center Hospital, Durango, CO, CCN 060013
  • Montrose Regional Health Hospital, Montrose, CO, CCN 060006

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0050420COMDNeurology Physician
LL15994ORMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Grand Junction, LLC CurrentSince May 20, 2014 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince May 20, 2014 Accepting new patients
St Mary'S Hospital and Medical Center, Inc CurrentSince Feb 20, 2012 Accepting new patients

Locations

2635 N 7th St
Grand Junction, CO 81501
Phone (970) 244-2009

750 Wellington Ave
Ste 3C
Grand Junction, CO 81501
Phone (970) 243-7908

1050 Wellington Ave
Slp Ctr
Grand Junction, CO 81501
Phone (970) 298-5864

1050 Wellington Ave
Grand Junction, CO 81501
Phone (970) 245-4810

450 W Williams Way
Moab, UT 84532
Phone (435) 259-7191

Interoperability endpoints

  • Direct secure messaging: lmcdaneld56542@direct.intermountainhealth.org

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 9

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": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471564800000",
    "number": "1619001633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2635 N 7TH ST",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815018209",
            "telephone_number": "970-298-2273",
            "fax_number": "970-298-1809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 WELLINGTON AVE",
            "address_2": "STE 3C",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815016132",
            "telephone_number": "970-298-3150",
            "fax_number": "970-298-3151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDANELD",
        "first_name": "LOGAN",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-14",
        "last_updated": "2016-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OR",
            "license": "LL15994",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CO",
            "license": "DR.0050420",
            "primary": false
        },
        {
            "code": "2084V0102X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Vascular Neurology",
            "state": "CO",
            "license": "DR.0050420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Junction, CO

Sources for this page

Verify at the official NPI Registry.