Individual provider Active NPI

Peter Gordon Vondoersten, MD

  • Otolaryngology Physician
  • Missoula, MT
National Provider Identifier
1619962990
Registry record updated Apr 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
8110 Issued in MT
Practice address
700 W Kent Ave
Missoula, MT 59801-6772
Phone
(406) 541-3277
Fax
(406) 541-3950
NPI assigned
Sep 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 8110 MT Primary

Addresses

Primary practice location

700 W Kent Ave
Missoula, MT 59801-6772

Mailing address

PO Box 4907
700 West Kent
Missoula, MT 59806-4907
Phone (406) 541-3277

Other practice location 1

2760 Elizabeth Warren Ave Ste B
Butte, MT 59701-3979
Phone (406) 792-1250

Other practice location 2

120 S 5th St Ste 104
Hamilton, MT 59840-2798
Phone (406) 363-3366

Other practice location 3

925 Highland Blvd Ste 1160
Bozeman, MT 59715-6905
Phone (406) 414-3780

Other identifiers 3

IdentifierTypeStateIssuer
0019773MedicaidMT
118619100MedicaidWY
804154700MedicaidID

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pvondoersten9871132@direct.sanfordhealth.org Direct Bozeman Health Deaconess Hospital

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111104000424 MT Practitioner - Otolaryngology 3173415817 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Missouri, Columbia School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence St Joseph Medical CenterGroup PAC ID 0446230247, shared by 5 NPIs, 52 clinicians
Rocky Mountain Ear Nose and Throat Center PCGroup PAC ID 3678472099, 20 clinicians

Practice addresses (Care Compare)

6 13TH Ave E
Polson, MT 59860-5315
Phone (406) 883-5377

700 W Kent Ave
Missoula, MT 59801-6772
Phone (406) 541-3937

Hospital & facility affiliations

  • St. Patrick Hospital Hospital, Missoula, MT, CCN 270014
  • Bitterroot Health - Daly Hospital Hospital, Hamilton, MT, CCN 271340
  • Providence St Joseph Medical Center Hospital, Polson, MT, CCN 271343
  • Billings Clinic Hospital Hospital, Billings, MT, CCN 270004
  • St James Hospital Hospital, Butte, MT, CCN 270017

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8110MTMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bozeman Health Deaconess Hospital Current Accepting new patients
Bozeman Health Deaconess Hospital CurrentSince Jan 6, 2022 Accepting new patients
Rocky Mountain Ear Nose & Throat Center PC Otolaryngology CurrentSince Jan 1, 2001 Accepting new patients
Marcus Daly Memorial Hospital Corp CurrentSince Dec 14, 2022 Accepting new patients
Marcus Daly Memorial Hospital Corporation Current Accepting new patients
Bozeman Health Deaconess Hospital CurrentSince Jan 6, 2022 Accepting new patients
Marcus Daly Memorial Hospital Corporation CurrentSince Dec 14, 2022 Accepting new patients
Providence St Joseph Medical Center CurrentSince Jan 1, 2017 Accepting new patients
Providence St Joseph Medical Center CurrentSince Dec 29, 2025 Accepting new patients
Credena Health LLC CurrentSince Jan 1, 2017 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

925 Highland Blvd
Ste 1160
Bozeman, MT 59715
Phone (406) 414-3780

925 Highland Blvd
Ste 1220
Bozeman, MT 59715
Phone (406) 414-3780

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

2760 Elizabeth Warren Ave
Ste B
Butte, MT 59701
Phone (406) 792-1250

120 S 5th St
Ste 104
Hamilton, MT 59840
Phone (406) 363-3366

1224 W Main St
Hamilton, MT 59840
Phone (406) 375-4823

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

700 W Kent Ave
Missoula, MT 59801
Phone (406) 541-3277

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

Interoperability endpoints

  • Direct secure messaging: pvondoersten207096@wm.providencedirect.org

Organizations & group practices 11

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744243200000",
    "number": "1619962990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4907",
            "address_2": "700 WEST KENT",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598064907",
            "telephone_number": "406-541-3277",
            "fax_number": "406-541-3950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W KENT AVE",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598016772",
            "telephone_number": "406-541-3277",
            "fax_number": "406-541-3950"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2760 Elizabeth Warren Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Butte",
            "state": "MT",
            "postal_code": "597013979",
            "country_code": "US",
            "telephone_number": "406-792-1250",
            "fax_number": "406-541-3811",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 S 5th St Ste 104",
            "address_purpose": "LOCATION",
            "city": "Hamilton",
            "state": "MT",
            "postal_code": "598402798",
            "country_code": "US",
            "telephone_number": "406-363-3366",
            "fax_number": "406-541-3811",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "925 Highland Blvd Ste 1160",
            "address_purpose": "LOCATION",
            "city": "Bozeman",
            "state": "MT",
            "postal_code": "597156905",
            "country_code": "US",
            "telephone_number": "406-414-3780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VONDOERSTEN",
        "first_name": "PETER",
        "middle_name": "GORDON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MT",
            "license": "8110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019773",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118619100",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804154700",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pvondoersten9871132@direct.sanfordhealth.org",
            "affiliation": "Y",
            "affiliationName": "Bozeman Health Deaconess Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "915 Highland Blvd",
            "city": "Bozeman",
            "state": "MT",
            "country_code": "US",
            "postal_code": "597156902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.