Active NPI
Derek Gavin Vines, M.D.
- Psychiatry Physician
- Bozeman, MT
National Provider Identifier
1720122203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 26173
- Practice address
- 950 W. Grant St. Student Wellness Center
Medical Services, Suite 2200
Bozeman, MT 59717 - Phone
- (406) 994-2311
- NPI assigned
- Feb 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 26173 | MT | Primary |
Addresses
Primary practice location
950 W. Grant St. Student Wellness Center
Medical Services, Suite 2200
Bozeman, MT 59717
Mailing address
208 Flynn Ave
Suite 3J
Burlington, VT 05401-5429
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26173 | MT | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743120000000",
"number": "1720122203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 FLYNN AVE",
"address_2": "SUITE 3J",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054015429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 W. GRANT ST. STUDENT WELLNESS CENTER",
"address_2": "MEDICAL SERVICES, SUITE 2200",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "59717",
"telephone_number": "406-994-2311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VINES",
"first_name": "DEREK",
"middle_name": "GAVIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-16",
"last_updated": "2025-03-28",
"certification_date": "2025-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MT",
"license": "26173",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bozeman, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.