NPIMap

Individual provider Active NPI

John R Gannon, M.D.

  • Urology Physician
  • Bozeman, MT
National Provider Identifier
1861634289
Registry record updated Apr 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MED-PHYS-LIC-58876 Issued in MT
Practice address
931 Highland Blvd Ste 3360
Bozeman, MT 59715-6914
Phone
(406) 414-5300
NPI assigned
Mar 31, 2009
Last updated
Apr 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 208800000X WA
Urology Physician 208800000X MED-PHYS-LIC-58876 MT Primary

Addresses

Primary practice location

931 Highland Blvd Ste 3360
Bozeman, MT 59715-6914

Mailing address

915 Highland Blvd
Bozeman, MT 59715-6902
Phone (406) 414-1671

Other practice location 1

334 Town Center Ave
Big Sky, MT 59716
Phone (406) 414-5000

Other practice location 2

4245 Roosevelt Way NE
Suite 300
Seattle, WA 98105-6008
Phone (206) 598-6358

Other identifiers 1

IdentifierTypeStateIssuer
1861634289MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jgannon10498340@direct.sanfordhealth.org Direct Bozeman Health Deaconess Hospital

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171101003365 MT Practitioner - Urology 0648403741 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Medical College of Wisconsin, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bozeman Health Deaconess HospitalGroup PAC ID 4688984164, 309 clinicians

Practice addresses (Care Compare)

875 S Cottonwood Rd
Bozeman, MT 59718-4221

915 Highland Blvd
Bozeman, MT 59715-6902
Phone (406) 414-5000

925 Highland Blvd
Bozeman, MT 59715-6900

925 Highland Blvd
Suite 1220
Bozeman, MT 59715-6905
Phone (406) 414-3780

931 Highland Blvd
Bozeman, MT 59715-6914

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.04 of 100Reported as group
Quality
84.13
Promoting interoperability
100
Improvement activities
40
Cost
72.66

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MED-PHYS-LIC-58876MTMDUrology Physician
208800000XWAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bozeman Health Deaconess Hospital CurrentSince Nov 1, 2017 Accepting new patients
Bozeman Health Deaconess Hospital CurrentSince Nov 1, 2017 Accepting new patients
Belgrade Clinic PLLP Current Accepting new patients
Bozeman Health Big Sky Medical Center, LLC CurrentSince Nov 24, 2024 Accepting new patients
Bozeman Health Deaconess Hospital Urology Current Accepting new patients
Bozeman Health Big Sky Medical Center, LLC CurrentSince Nov 24, 2024 Accepting new patients
Bozeman Health Deaconess Hospital Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

915 Highland Blvd
Bozeman, MT 59715
Phone (406) 414-1720

925 Highland Blvd
Bozeman, MT 59715
Phone (406) 414-3780

925 Highland Blvd
Ste 1220
Bozeman, MT 59715
Phone (406) 414-3780

931 Highland Blvd
Ste 3360
Bozeman, MT 59715
Phone (406) 414-5300

935 Highland Blvd
Ste 2160
Bozeman, MT 59715
Phone (406) 414-5300

935 Highland Blvd
Ste 3360
Bozeman, MT 59715
Phone (406) 414-5300

Interoperability endpoints

  • Direct secure messaging: jgannon10498340@direct.sanfordhealth.org

Organizations & group practices 8

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 11

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": "1238457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744243200000",
    "number": "1861634289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 HIGHLAND BLVD",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597156902",
            "telephone_number": "406-414-1671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 HIGHLAND BLVD STE 3360",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597156914",
            "telephone_number": "406-414-5300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "334 Town Center Ave",
            "address_purpose": "LOCATION",
            "city": "Big Sky",
            "state": "MT",
            "postal_code": "59716",
            "country_code": "US",
            "telephone_number": "406-414-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4245 Roosevelt Way NE",
            "address_2": "Suite 300",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981056008",
            "country_code": "US",
            "telephone_number": "206-598-6358",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GANNON",
        "first_name": "JOHN",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-31",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WA",
            "license": "208800000X",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MT",
            "license": "MED-PHYS-LIC-58876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861634289",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jgannon10498340@direct.sanfordhealth.org",
            "affiliation": "Y",
            "affiliationName": "Bozeman Health Deaconess Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "935 Highland Blvd Ste 2160",
            "city": "Bozeman",
            "state": "MT",
            "country_code": "US",
            "postal_code": "597156913",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bozeman, MT

Sources for this page

Verify at the official NPI Registry.