Active NPI
Stacey Laura Gividen, DDS
- Dentist
- Hamilton, MT
National Provider Identifier
1871701854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2141
- Practice address
- 710 N 1St St
Hamilton, MT 59840-2134 - Phone
- (406) 375-1192
- Fax
- (406) 375-1193
- NPI assigned
- May 21, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2141 | MT | |
| Dentist | 122300000X | 2141 | MT | Primary |
Addresses
Primary practice location
710 N 1St St
Hamilton, MT 59840-2134
Mailing address
710 N 1St St
Hamilton, MT 59840-2134
Phone (406) 375-1192
Other names 1
- Dr. Stacey Laura Simmons
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150714002850 | MT | Order and Referring Only - Dentist | 4789997115 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2141 | MT | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Canyon View Dental PC | General Practice | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557705600000",
"number": "1871701854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 N 1ST ST",
"city": "HAMILTON",
"state": "MT",
"postal_code": "598402134",
"telephone_number": "406-375-1192",
"fax_number": "406-375-1193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 N 1ST ST",
"city": "HAMILTON",
"state": "MT",
"postal_code": "598402134",
"telephone_number": "406-375-1192",
"fax_number": "406-375-1193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIVIDEN",
"first_name": "STACEY",
"middle_name": "LAURA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-21",
"last_updated": "2019-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MT",
"license": "2141",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MT",
"license": "2141",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "STACEY",
"last_name": "SIMMONS",
"middle_name": "LAURA",
"prefix": "DR.",
"credential": "DDS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Hamilton, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2019; 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.