Individual provider Active NPI

Erika Hagstrom, MD

  • Dermatology Physician
  • Missoula, MT
National Provider Identifier
1841685658
Registry record updated Jul 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
113618 Issued in MT
Practice address
2835 Fort Missoula Rd BLDG 3
Missoula, MT 59804-7423
Phone
(406) 721-5600
NPI assigned
Mar 30, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 287108 MA
Dermatology Physician 207N00000X MD60769542 WA
MOHS-Micrographic Surgery Physician 207ND0101X MD60769542 WA
Dermatology Physician 207N00000X 113618 MT Primary

Addresses

Primary practice location

2835 Fort Missoula Rd BLDG 3
Missoula, MT 59804-7423

Mailing address

PO Box 7609
Missoula, MT 59807-7609
Phone (406) 721-5600

Other practice location 1

510 S Cowley St
Spokane, WA 99202-1332
Phone (509) 252-1299

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ehagstrom2482438@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240718004059 WA Practitioner - Dermatology 2961705595 Reassigns benefits to 1 organization
I20240917004149 OR Practitioner - DermatologyPractitioner - Micrographic Dermatologic Surgery (MDS) 2961705595 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
DermatologyAlso: Micrographic Dermatologic Surgery (MDS)
Education
Loyola University of Chicago, Stritch School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2747 NE Conners Ave
Bend, OR 97701-8738
Phone (541) 382-5712

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.1 of 100Reported as group
Quality
86.66
Promoting interoperability
77
Improvement activities
40
Cost
72.83

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision50
Removal of tissue1-10
Removal of skin lesions67
Removal of skin cancer603
Skin biopsy53

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
287108MAMDDermatology Physician
113618MTMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain West Derm - Blackhart PLLC Dermatology CurrentSince Nov 1, 2024 Accepting new patients
Mountain West Derm-Blackhart, PLLC Dermatology CurrentSince Nov 1, 2024 Accepting new patients
Chesnut MD Dermatology CurrentSince Jun 20, 2024 Accepting new patients
Bend Dermatology Clinic LLC Dermatology Current Accepting new patients
Mountain West Derm - Blackhart PLLC Dermatology Past Accepting new patients

Locations

2747 NE Conners Ave
Bend, OR 97701
Phone (541) 322-1980

2705 NE Conners Ave
Bend, OR 97701
Phone 51293039091255

1334 N Whitman Ln
Ste 200
Liberty Lake, WA 99019

510 S Cowley St
Spokane, WA 99202
Phone (509) 252-1299

Interoperability endpoints

  • Direct secure messaging: ehagstrom2482438@wm.providencedirect.org

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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": "1427673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721952000000",
    "number": "1841685658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7609",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598077609",
            "telephone_number": "406-721-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2835 FORT MISSOULA RD BLDG 3",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598047423",
            "telephone_number": "406-721-5600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "510 S Cowley St",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992021332",
            "country_code": "US",
            "telephone_number": "509-252-1299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAGSTROM",
        "first_name": "ERIKA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-30",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MA",
            "license": "287108",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WA",
            "license": "MD60769542",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "WA",
            "license": "MD60769542",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MT",
            "license": "113618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ehagstrom2482438@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2835 Fort Missoula Rd Bldg 3",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598047423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.