Individual provider Active NPI

Marisa Renee Llamas

  • Physician Assistant
  • Missoula, MT
National Provider Identifier
1841067832
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MED-PAC-LIC-144583- Issued in MT
Practice address
2740 South Ave W Ste 101
Missoula, MT 59804-5137
Phone
(406) 728-6101
NPI assigned
Dec 8, 2023
Last updated
Dec 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MED-PAC-LIC-144583- MT Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

2740 South Ave W Ste 101
Missoula, MT 59804-5137

Mailing address

60386 E Loose Reins PL
Tucson, AZ 85739-5903

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241211003858 MT Practitioner - Physician Assistant 4789110909 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Rockies Orthopaedics, PLLPGroup PAC ID 6507766227, 25 clinicians

Practice addresses (Care Compare)

2740 S Ave W
Suite 101
Missoula, MT 59804-5137
Phone (406) 728-6101

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MED-PAC-LIC-144583-MTMDPhysician Assistant

Organizations & group practices 1

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 5

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": "1701993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1841067832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60386 E LOOSE REINS PL",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857395903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 SOUTH AVE W STE 101",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598045137",
            "telephone_number": "406-728-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LLAMAS",
        "first_name": "MARISA",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-08",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "MED-PAC-LIC-144583-",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.