Michael C Dicello, MD

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

11976 Issued in MT

Practice address

1188 N 15TH Ave Ste 3
Bozeman, MT 59715-3290

Phone

(406) 582-1111

Fax

(406) 582-1112

NPI assigned

Jun 14, 2005

Last updated

Jul 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

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

Specialty

Allergy/ImmunologyAlso: Internal Medicine

Education

Ohio State University College of Medicine, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Equanimity Health Care PCGroup PAC ID 2365614369, 2 clinicians

Livingston HealthcareGroup PAC ID 5991613598, shared by 4 NPIs, 66 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bozeman Health Deaconess Hospital Hospital, Bozeman, MT, CCN 270057

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Equanimity Health Care, P.C.

  • Medical Specialty Clinic/Center
  • Bozeman, MT
  • NPI 1356637656
  Medicare reassignment Care Compare group NPD Authorized official
• Timber Lane Allergy & Asthma Associates, PC

  • Allergy & Immunology Physician
  • South Burlington, VT
  • NPI 1457356818
  NPD (past)

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

• Bozeman Health Deaconess Hospital

  • General Acute Care Hospital
  • Bozeman, MT
  • NPI 1104295864
  Care Compare affiliation

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1720083173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1188 N 15TH AVE STE 3",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597153290",
            "telephone_number": "406-582-1111",
            "fax_number": "406-582-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1188 N 15TH AVE STE 3",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597153290",
            "telephone_number": "406-582-1111",
            "fax_number": "406-582-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICELLO",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "VT",
            "license": "42-000-9879",
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "MT",
            "license": "11976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01961568",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NORTHEAST NEW YORK",
            "identifier": "96G431",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0VN1993",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "7525992-001",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "03V100",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD VT",
            "identifier": "48079",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Deshano, ACLC
• Siri Devlin, LCPC
• Autumn Devries, LMT
• Shannyn Sarah Dewey, CNM
• Jacina Joy Dezell
• Charlotte Dickson, LCPC
• Keegan Joseph Diehl, PHD
• Kelly Diehl
• Suzanne Dierkes
• Kathryn Townsend Distin, RN

• Allergy & Immunology Physician in Bozeman, MT
• Providers in Bozeman, MT by specialty
• Allergy & Immunology Physician in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.