NPIMap

Individual provider Active NPI

Brad Peterson, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Missoula, MT
National Provider Identifier
1730132820
Registry record updated Sep 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
9730 Issued in MT
Practice address
2827 Fort Missoula Road
Community Medical Center, Dept. of Pathology
Missoula, MT 59804-7408
Phone
(406) 327-4330
Fax
(406) 327-4515
NPI assigned
May 18, 2006
Last updated
Sep 14, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 9730 MT Primary

Addresses

Primary practice location

2827 Fort Missoula Road
Community Medical Center, Dept. of Pathology
Missoula, MT 59804-7408

Mailing address

PO Box 30382
Billings, MT 59107-0382
Phone (888) 843-8475

Other identifiers 1

IdentifierTypeStateIssuer
0036584MedicaidMT

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
I20101130000843 MT Practitioner - PathologyPractitioner - Other (Physician) 1951597137 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Utah School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pathology Consultants of Western Montana PCGroup PAC ID 2769377548, 2 clinicians

Practice addresses (Care Compare)

500 W Broadway St
Missoula, MT 59802-4008
Phone (406) 552-4994

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.5 of 100Reported as group
Quality
85
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9730MTMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marcus Daly Memorial Hospital Corporation CurrentSince Dec 7, 2024 Accepting new patients
Marcus Daly Memorial Hospital Corporation Current Accepting new patients
Pathology Consultants of Western Montana, P.C. Anatomic Pathology & Clinical Pathology CurrentSince Aug 1, 2001 Accepting new patients
Marcus Daly Memorial Hospital Corporation CurrentSince Dec 7, 2024 Accepting new patients

Locations

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

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

2827 Fort Missoula Rd
Missoula, MT 59804
Phone (406) 327-4202

500 W Broadway St
Missoula, MT 59802
Phone (406) 327-1918

Organizations & group practices 4

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 11

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": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473811200000",
    "number": "1730132820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30382",
            "city": "BILLINGS",
            "state": "MT",
            "postal_code": "591070382",
            "telephone_number": "888-843-8475",
            "fax_number": "314-849-6395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2827 FORT MISSOULA ROAD",
            "address_2": "COMMUNITY MEDICAL CENTER, DEPT. OF PATHOLOGY",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598047408",
            "telephone_number": "406-327-4330",
            "fax_number": "406-327-4515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BRAD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2016-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MT",
            "license": "9730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0036584",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.