NPIMap

Individual provider Active NPI

David L Nieman, PA-C

  • Medical Physician Assistant
  • Glendive, MT
National Provider Identifier
1760568869
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
107 Dilworth St
Glendive, MT 59330-2053
Phone
(406) 345-8935
Fax
(406) 345-8908
NPI assigned
Oct 31, 2006
Last updated
Aug 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA10004978 WA
Medical Physician Assistant 363AM0700X MT Primary

Addresses

Primary practice location

107 Dilworth St
Glendive, MT 59330-2053

Mailing address

107 Dilworth St
Glendive, MT 59330-2053
Phone (406) 345-8935

Other practice location 1

1287 Burns Way
Kalispell, MT 59901-3109
Phone (406) 752-8120

Other identifiers 4

IdentifierTypeStateIssuer
9947NIOtherWAREGENCE RIDER
0207865OtherWAL&I
8941215OtherWAL&I CVC
8500225MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Krmcmedicalrecords@krhdirect.org Direct Kalispell Regional Medical Center, Inc

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
I20140409001577 MT Practitioner - Physician Assistant 0840200101 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1273 Burns Way
Kalispell, MT 59901-3109
Phone (406) 752-8300

350 Heritage Way
Kalispell, MT 59901-3167

8299 Mt Hwy 35
Bigfork, MT 59911-3583
Phone (406) 837-5541

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kalispell Regional Medical Center, Inc CurrentSince Jan 1, 2021 Accepting new patients
Glendive Medical Center, Inc CurrentSince Mar 18, 2019 Accepting new patients
Glendive Medical Center, Inc CurrentSince Mar 18, 2019 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Kalispell Regional Medical Center Inc CurrentSince Jan 1, 2021 Accepting new patients
Kalispell Regional Medical Center, Inc Past Accepting new patients

Locations

107 Dilworth St
Glendive, MT 59330
Phone (406) 345-8900

202 Prospect Dr
Glendive, MT 59330
Phone (406) 345-3306

1287 Burns Way
Kalispell, MT 59901
Phone (406) 752-8120

202 Conway Dr
Ste 100
Kalispell, MT 59901
Phone (406) 751-5666

310 Sunnyview Ln
Kalispell, MT 59901
Phone (406) 751-5310

350 Heritage Way
Ste 1200
Kalispell, MT 59901
Phone (406) 756-4112

350 Heritage Way
Ste 2100
Kalispell, MT 59901
Phone (406) 257-8992

Interoperability endpoints

  • Direct secure messaging: krmcmedicalrecords@krhdirect.org

Organizations & group practices 7

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 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": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1760568869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 DILWORTH ST",
            "city": "GLENDIVE",
            "state": "MT",
            "postal_code": "593302053",
            "telephone_number": "406-345-8935",
            "fax_number": "406-345-8908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 DILWORTH ST",
            "city": "GLENDIVE",
            "state": "MT",
            "postal_code": "593302053",
            "telephone_number": "406-345-8935",
            "fax_number": "406-345-8908"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1287 Burns Way",
            "address_purpose": "LOCATION",
            "city": "Kalispell",
            "state": "MT",
            "postal_code": "599013109",
            "country_code": "US",
            "telephone_number": "406-752-8120",
            "fax_number": "406-752-8134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIEMAN",
        "first_name": "DAVID",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004978",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE RIDER",
            "identifier": "9947NI",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0207865",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I CVC",
            "identifier": "8941215",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8500225",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center, Inc",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1287 Burns Way",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599013109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Glendive, MT

Sources for this page

Verify at the official NPI Registry.