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Organization Active NPI

Providence Health & Services Mt

Doing business as PMG MT IHI Montana Cardiology

  • Interventional Cardiology Physician
  • Missoula, MT
National Provider Identifier
1649401076
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
Legal business name
PROVIDENCE HEALTH & SERVICES MT
Doing business as
PMG MT IHI Montana Cardiology
Providence Medical Group Montana
Practice address
2829 Great Northern Loop
Suite 300
Missoula, MT 59808-1752
Phone
(406) 541-7000
NPI assigned
Aug 3, 2009
Last updated
May 7, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X Primary

Addresses

Primary practice location

2829 Great Northern Loop
Suite 300
Missoula, MT 59808-1752

Mailing address

PO Box 31001 - 4114
Pasadena, CA 91110-4114

Other names 2

  • PMG MT IHI Montana Cardiology Doing business as
  • PROVIDENCE MEDICAL GROUP MONTANA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT, ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031229000787 MT Part B Supplier - Clinic/Group Practice 6608786306 Receives reassigned benefits from 382 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Missoula, MT; Plains, MT; Polson, MT; St Ignatius, MT; Stevensville, MT; Anaconda, MT; Butte, MT; Corvallis, MT…
O20101227000036 ID Part B Supplier - Clinic/Group Practice 6608786306 Receives reassigned benefits from 5 practitioners
2 other NPIs on this enrollment
Practice locations: Boise, ID; Salmon, ID; Kuna, ID

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Weston Mark G39 organizations share this tax ID, including this one
Part of
Providence Service Corporation

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Ownership & related parties

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Providence St Patrick HospitalMissoula, MT, CCN 270014 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2010
Providence St Joseph Medical CenterPolson, MT, CCN 271343 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2010
Jan 1, 2010
Providence St Joseph Medical CenterPolson, MT, CCN 27Z343 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 1, 2010
Jan 1, 2010
The Village Health & RehabilitationMissoula, MT, CCN 275043 Skilled nursing facility Other Nov 1, 2013
Riverside Health & RehabilitationMissoula, MT, CCN 275126 Skilled nursing facility Other Nov 1, 2013
Partners in Home Care IncMissoula, MT, CCN 277032 Home health agency Operational/Managerial Control Aug 11, 1987
Partners in Home Care IncMissoula, MT, CCN 271500 Hospice Operational/Managerial Control Aug 11, 1987
Providence St Joseph Medical Center - RonanRonan, MT, CCN 273416 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Dec 18, 2009
Dec 18, 2009
Providence St Joseph Medical Center - PolsonPolson, MT, CCN 273415 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Dec 18, 2009
Dec 18, 2009

Owned or controlled facilities with NPI records 12

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1249257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746576000000",
    "number": "1649401076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 4114",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2829 GREAT NORTHERN LOOP",
            "address_2": "SUITE 300",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081752",
            "telephone_number": "406-541-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES MT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES",
        "enumeration_date": "2009-08-03",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PMG MT IHI Montana Cardiology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PMG MT IHI Montana Cardiology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP MONTANA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.