NPIMap

Individual provider Active NPI

Samuel Roger Kirkeide

  • Physician Assistant
  • Missoula, MT
National Provider Identifier
1710766274
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MED-PAC-LIC-130126 Issued in MT
Practice address
2740 South Ave W Ste 101
Missoula, MT 59804-5137
Phone
(406) 728-6101
NPI assigned
Sep 25, 2023
Last updated
Sep 25, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 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 MED-PAC-LIC-130126 MT Primary

Addresses

Primary practice location

2740 South Ave W Ste 101
Missoula, MT 59804-5137

Mailing address

2740 South Ave W Ste 101
Missoula, MT 59804-5137
Phone (406) 728-6101

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
I20240103002023 MT Practitioner - Physician Assistant 2567812522 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Rockies Orthopaedics, PLLPGroup PAC ID 6507766227, 25 clinicians

Practice addresses (Care Compare)

2740 S Ave W
Suite 101
Missoula, MT 59804-5137
Phone (406) 728-6101

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MED-PAC-LIC-130126MTMDPhysician Assistant

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695600000000",
    "number": "1710766274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 SOUTH AVE W STE 101",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598045137",
            "telephone_number": "406-728-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 SOUTH AVE W STE 101",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598045137",
            "telephone_number": "406-728-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRKEIDE",
        "first_name": "SAMUEL",
        "middle_name": "ROGER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-09-25",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "MED-PAC-LIC-130126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.