Active NPI
Randall Logan
- Athletic Trainer
- Great Falls, MT
National Provider Identifier
1801203039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 10157554
- Practice address
- 228 17TH Ave NW
Great Falls, MT 59404-1807 - Phone
- (406) 454-6973
- NPI assigned
- Jul 21, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 10157554 | OR | Primary |
Addresses
Primary practice location
228 17TH Ave NW
Great Falls, MT 59404-1807
Mailing address
601 1St Ave N
Great Falls, MT 59401-2510
Phone (406) 454-6973
Other practice location 1
527 SE Hall St.
Portland, OR 97201
Phone (503) 725-4000
Other practice location 2
510 1st Ave N
Great Falls, MT 59401-2592
Phone (406) 454-6973
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10157554 | OR | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health Care Center Incorporated | Past | Accepting new patients | |
| County of Cascade | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Federally Qualified Health Center (FQHC)
- Great Falls, MT
- NPI 1902948946
-
- Family Nurse Practitioner
- Great Falls, MT
- NPI 1972645901
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712102400000",
"number": "1801203039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 1ST AVE N",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594012510",
"telephone_number": "406-454-6973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "228 17TH AVE NW",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594041807",
"telephone_number": "406-454-6973"
}
],
"practiceLocations": [
{
"address_1": "527 SE Hall St.",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "97201",
"country_code": "US",
"telephone_number": "503-725-4000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "510 1st Ave N",
"address_purpose": "LOCATION",
"city": "Great Falls",
"state": "MT",
"postal_code": "594012592",
"country_code": "US",
"telephone_number": "406-454-6973",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LOGAN",
"first_name": "RANDALL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-21",
"last_updated": "2024-04-03",
"certification_date": "2024-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OR",
"license": "10157554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Falls, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.