NPIMap

Individual provider Active NPI

David Ezra Nolan, PA-C

  • Physician Assistant
  • Hamilton, MT
National Provider Identifier
1669464392
Registry record updated Jun 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0292 Issued in MT
Practice address
312 Fair Grounds Road
Hamilton, MT 59840
Phone
(406) 361-7680
Fax
(406) 363-4060
NPI assigned
Aug 18, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2013

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0292 MT Primary
Medical Physician Assistant 363AM0700X 0292 MT
Surgical Physician Assistant 363AS0400X 0292 MT

Addresses

Primary practice location

312 Fair Grounds Road
Hamilton, MT 59840

Mailing address

312 Fair Grounds Road
Hamilton, MT 59840
Phone (406) 361-7680

Other identifiers 1

IdentifierTypeStateIssuer
4310345MedicaidMT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050408001001 MT Practitioner - Physician Assistant 1254378441 Reassigns benefits to 2 organizations
I20111025000538 ID Practitioner - Physician Assistant 1254378441 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Steele Memorial Medical CenterGroup PAC ID 9436131265, 25 clinicians

Practice addresses (Care Compare)

203 S Daisy St
Salmon, ID 83467-4709
Phone (208) 756-5600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
292MTMDProfessional Counselor
0292MTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Marcus Daly Memorial Hospital Corp CurrentSince May 9, 2022 Accepting new patients
Marcus Daly Memorial Hospital Corporation CurrentSince May 9, 2022 Accepting new patients
Marcus Daly Memorial Hospital Corporation Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

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

1200 Westwood Dr
Ste H
Hamilton, MT 59840
Phone (406) 375-4790

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

3975 US Highway 93 N
Stevensville, MT 59870
Phone (406) 375-4824

Organizations & group practices 5

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 6

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": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372118400000",
    "number": "1669464392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 FAIR GROUNDS ROAD",
            "city": "HAMILTON",
            "state": "MT",
            "postal_code": "59840",
            "telephone_number": "406-361-7680",
            "fax_number": "406-363-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 FAIR GROUNDS ROAD",
            "city": "HAMILTON",
            "state": "MT",
            "postal_code": "59840",
            "telephone_number": "406-361-7680",
            "fax_number": "406-363-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOLAN",
        "first_name": "DAVID",
        "middle_name": "EZRA",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2013-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "0292",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MT",
            "license": "0292",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MT",
            "license": "0292",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4310345",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamilton, MT

Sources for this page

Verify at the official NPI Registry.