NPIMap

Individual provider Active NPI

Myrna Jeanie Mentikov, PA-C

  • Physician Assistant
  • Billings, MT
National Provider Identifier
1750377735
Registry record updated Jun 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
362 Issued in MT
Practice address
123 S 27TH St
Billings, MT 59101-4200
Phone
(406) 247-3350
NPI assigned
Sep 23, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2013

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 362 MT Primary

Addresses

Primary practice location

123 S 27TH St
Billings, MT 59101-4200

Mailing address

123 S 27TH St
Billings, MT 59101-4227
Phone (406) 247-3350

Other identifiers 1

IdentifierTypeStateIssuer
4302571MedicaidMT

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
I20040326000500 MT Practitioner - Physician Assistant 1658263421 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yellowstone City-County Health DeptGroup PAC ID 1456259159, 53 clinicians

Practice addresses (Care Compare)

123 S 27TH St
Billings, MT 59101-4227
Phone (406) 247-3200

Hospital & facility affiliations

  • Billings Clinic Hospital Hospital, Billings, MT, CCN 270004
  • Intermountain Health St Vincent Regional Hospital Hospital, Billings, MT, CCN 270049

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
362MTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Yellowstone City-County Health Department CurrentSince Nov 28, 2003 Accepting new patients
Yellowstone City-County Health Dept CurrentSince Nov 28, 2003 Accepting new patients
Yellowstone City-County Health Department Past Accepting new patients

Locations

123 S 27th St
Billings, MT 59101
Phone (406) 247-3200

2469 Main St
Worden, MT 59088
Phone (406) 967-2255

Organizations & group practices 3

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

Hospital & facility affiliations 10

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": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372118400000",
    "number": "1750377735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 S 27TH ST",
            "city": "BILLINGS",
            "state": "MT",
            "postal_code": "591014227",
            "telephone_number": "406-247-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 S 27TH ST",
            "city": "BILLINGS",
            "state": "MT",
            "postal_code": "591014200",
            "telephone_number": "406-247-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENTIKOV",
        "first_name": "MYRNA",
        "middle_name": "JEANIE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-23",
        "last_updated": "2013-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "362",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4302571",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Billings, MT

Sources for this page

Verify at the official NPI Registry.