Jacob Michael Taverna, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

7657 Issued in MT

Practice address

435 S Crystal St
Suite 300
Butte, MT 59701-1506

Phone

(406) 496-3600

Fax

(406) 496-3653

NPI assigned

Nov 15, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• SCL Health Medical Group-Butte LLC

  • Family Medicine Physician
  • Butte, MT
  • NPI 1477869600
  Medicare reassignment NPD
• SCL Health Medical Group-Butte LLC

  • Rural Health Clinic/Center
  • Boulder, MT
  • NPI 1861031122
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200873600000",
    "number": "1811979099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 S CRYSTAL ST",
            "address_2": "SUITE 300",
            "city": "BUTTE",
            "state": "MT",
            "postal_code": "597011506",
            "telephone_number": "406-496-3600",
            "fax_number": "406-496-3653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 S CRYSTAL ST",
            "address_2": "SUITE 300",
            "city": "BUTTE",
            "state": "MT",
            "postal_code": "597011506",
            "telephone_number": "406-496-3600",
            "fax_number": "406-496-3653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVERNA",
        "first_name": "JACOB",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2008-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MT",
            "license": "7657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006 4818",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Joy Swanson, PT
• Lule Swearengin
• Sweetwater Butte Opco LLC
• Deborah Jeanne Swiatkowski, R.D.
• Kristy Tate, LMT
• Tayler Rydalch Pmhnp-BC, LLC
• Christina Marie Taylor, RPH
• Mariion Christine Taylor, SWLC
• Nanci Louise Taylor, APRN
• Victoria Templin

• Internal Medicine Physician in Butte, MT
• Providers in Butte, MT by specialty
• Internal Medicine Physician in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.