Active NPI
Northern Nutrition Group, LLC
- Registered Dietitian
- Bozeman, MT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Legal business name
- NORTHERN NUTRITION GROUP, LLC
- Practice address
- 2002 N 22ND Ave Ste 2
Bozeman, MT 59718-3153 - Phone
- (406) 282-1398
- Fax
- (406) 551-1420
- NPI assigned
- Jan 16, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kimberly Johnson, RD
- Title
- Owner
- Phone
- (229) 560-8807
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
2002 N 22ND Ave Ste 2
Bozeman, MT 59718-3153
Mailing address
PO Box 73
Bozeman, MT 59771
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134654759 | Medicaid | MT | |
| 1740754472 | Medicaid | MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
300 N Willson Ave
Ste 602F-5
Bozeman, MT 59715
2002 N 22nd Ave
Ste 2
Bozeman, MT 59718
Phone (406) 282-1398
321 E Main St
Bozeman, MT 59715
Phone (218) 770-8660
115 W Kagy Blvd
Ste A
Bozeman, MT 59715
Phone (406) 282-1398
108 N 2nd St
Ste 202
Livingston, MT 59047
Phone (406) 282-1398
Practitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Registered Dietitian
- Grover Beach, CA
- NPI 1932867108
Dietitian, Registered, MT
-
- Registered Dietitian
- Richmond, MN
- NPI 1952909038
Dietitian, Registered, MT
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547596800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1655164800000",
"number": "1740754472",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 73",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "59771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2002 N 22ND AVE STE 2",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597183153",
"telephone_number": "406-282-1398",
"fax_number": "406-551-1420"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NORTHERN NUTRITION GROUP, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-01-16",
"last_updated": "2022-06-14",
"certification_date": "2022-06-14",
"status": "A",
"authorized_official_last_name": "JOHNSON",
"authorized_official_first_name": "KIMBERLY",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "229-560-8807",
"authorized_official_credential": "RD"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1134654759",
"state": "MT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1740754472",
"state": "MT"
}
],
"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 Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.