NPIMap

Individual provider Active NPI

Nicole Rachelle Sutter, PA-C

  • Physician Assistant
  • Missoula, MT
National Provider Identifier
1669710406
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
35302 Issued in MT
Practice address
3055 N Reserve St Ste D
Missoula, MT 59808-1395
Phone
(406) 327-7000
Fax
(406) 329-1927
NPI assigned
Jan 30, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 35302 MT Primary

Addresses

Primary practice location

3055 N Reserve St Ste D
Missoula, MT 59808-1395

Mailing address

PO Box 12
Liberty Lake, WA 99019-0012
Phone (866) 747-2455

Other practice location 1

6 13th Ave E
Polson, MT 59860-5315
Phone (406) 883-5680

Other names 1

  • Nicole Rachelle Banfield Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nbanfield507922@wm.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
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
I20150506001539 MT Practitioner - Physician Assistant 4486809357 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
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, 52 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

  • St. Patrick Hospital Hospital, Missoula, MT, CCN 270014
  • Providence St Joseph Medical Center Hospital, Polson, MT, CCN 271343
  • St Luke Community Hospital Hospital, Ronan, MT, CCN 271325
  • Steele Memorial Medical Center Hospital, Salmon, ID, CCN 131305
  • Deer Lodge Medical Center Hospital, Deer Lodge, MT, CCN 271314

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35302MTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence St Joseph Medical Center CurrentSince Jul 1, 2015 Accepting new patients
Credena Health LLC CurrentSince Jul 1, 2015 Accepting new patients
Providence Health & Services Mt Past Accepting new patients

Locations

500 W Broadway St
Fl 4
Missoula, MT 59802
Phone (406) 327-1900

500 W Broadway St
Ste 320
Missoula, MT 59802
Phone (406) 329-2945

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

Interoperability endpoints

  • Direct secure messaging: nbanfield507922@wm.providencedirect.org

Organizations & group practices 3

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 8

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": "1359504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1669710406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190012",
            "telephone_number": "866-747-2455",
            "fax_number": "406-329-1927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 N RESERVE ST STE D",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081395",
            "telephone_number": "406-327-7000",
            "fax_number": "406-329-1927"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6 13th Ave E",
            "address_purpose": "LOCATION",
            "city": "Polson",
            "state": "MT",
            "postal_code": "598605315",
            "country_code": "US",
            "telephone_number": "406-883-5680",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUTTER",
        "first_name": "NICOLE",
        "middle_name": "RACHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-30",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "35302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nbanfield507922@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "500 W Broadway St Fl 4",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "BANFIELD",
            "middle_name": "RACHELLE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.