Active NPI
Ivan T Van Eerden, D.C.
- Chiropractor
- Missoula, MT
National Provider Identifier
1801958061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 946
- Practice address
- 225 Hickory St
Missoula, MT 59801-1856 - Phone
- (406) 541-6400
- Fax
- (406) 728-8467
- NPI assigned
- Dec 14, 2006
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 946 | MT | Primary |
Addresses
Primary practice location
225 Hickory St
Missoula, MT 59801-1856
Mailing address
225 Hickory St
Missoula, MT 59801-1856
Phone (406) 541-6400
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0165512 | Medicaid | MT | |
| 40053 | Other | MT | BLUE CROSSBLUE SHIELD |
| 0165503 | Medicaid | MT | |
| ACN617836 | Other | MT | ACN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100923000249 | MT | Practitioner - Chiropractic | 1951427392 | Practice locations: Missoula, MT |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Western States College of Chiropractic, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
225 Hickory St
Missoula, MT 59801-1856
Phone (406) 541-6400
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801958061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 HICKORY ST",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598011856",
"telephone_number": "406-541-6400",
"fax_number": "406-728-8467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 HICKORY ST",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598011856",
"telephone_number": "406-541-6400",
"fax_number": "406-728-8467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN EERDEN",
"first_name": "IVAN",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MT",
"license": "946",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0165512",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSSBLUE SHIELD",
"identifier": "40053",
"state": "MT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0165503",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ACN",
"identifier": "ACN617836",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.