Jonathan A Bodine, D.O.
Individual provider Active NPI Internal Medicine Physician · Butte, MT
NPI 1760434740 · NPPES record last updated May 23, 2023
Key facts
- NPI
- 1760434740
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- OP60662799 (WA)
- Practice address
- 401 S Alabama St
Ste 3B
Butte, MT 59701-2315 - Phone
- (406) 723-4312
- Fax
- (406) 723-4316
- NPI assigned
- May 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MT, AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050815000902 | MT | Practitioner - Internal Medicine | 6608806120 | Reassigns benefits to 2 organizations |
| I20181207002017 | AZ | Practitioner - Internal Medicine | 6608806120 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10364 | MT | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| City of Hope Medical Group of Arizona LLC | Internal Medicine | Current |
Accepting new patients |
| Bodine Medical LLC | Internal Medicine | Current |
Accepting new patients |
| Hospitalist Medicine Physicians of Montana - TCS PC | Internal Medicine | Current |
Accepting new patients |
| Cogent Healthcare of Montana P C | Internal Medicine | Current |
Accepting new patients |
| St Luke'S Magic Valley Regional Medical Center LTD | Past | Accepting new patients |
Locations
14200 W Celebrate Life Way
Goodyear, AZ 85338
Phone (623) 207-3000
6897 Paysphere Cir
Chicago, IL 60674
Phone (480) 586-7542
1233 N 30th St
Billings, MT 59101
Phone (406) 237-3850
400 S Clark St
Butte, MT 59701
Phone (406) 495-7260
401 S Alabama St
Ste 3B
Butte, MT 59701
Phone (406) 723-4312
401 S Alabama St
Butte, MT 59701
Phone (406) 723-4026
1101 26th St S
Great Falls, MT 59405
Phone (406) 455-4690
1101 26th St S
Fl 5
Great Falls, MT 59405
Phone (406) 455-2132
2827 Fort Missoula Rd
Missoula, MT 59804
Phone (406) 327-4202
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 10364 | MT | |
| Internal Medicine Physician | 207R00000X | O-1460 | ID | |
| Internal Medicine Physician | 207R00000X | OP60662799 | WA | Yes |
Addresses
Primary practice location
401 S Alabama St
Ste 3B
Butte, MT 59701-2315
Mailing address
401 S Alabama St
Butte, MT 59701-2315
Other practice location 1
1615 Delaware St
Longview, WA 98632
Phone (360) 501-3601
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0153179 | Medicaid | MT |
Other providers in Butte, MT
- Nick Blavatsky
- Laura Beth Block
- Cody Philip Blom
- Blue Mountain Counseling
- Bodine Medical LLC
- Kerry Bohlken
- Timothy Bolewicz
- Carlye Bolstad
- Alyssa Bolton
- Loretta Lynn Bolyard
All providers in Butte, MT · Internal Medicine Physician in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.