NPIMap

Organization Active NPI

Sheila M Idzerda, MD PLLC

  • Primary Care Clinic/Center
  • Bozeman, MT
National Provider Identifier
1902252133
Registry record updated May 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
9597 Issued in MT
Legal business name
SHEILA M IDZERDA, MD PLLC
Practice address
1819 S 22ND Ave
Suite 100
Bozeman, MT 59718-7070
Phone
(406) 451-9118
NPI assigned
May 6, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2016

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

Authorized official

Name
Dr. Sheila M Idzerda, MD
Title
Owner
Phone
(406) 451-9118

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 9597 MT Primary

Addresses

Primary practice location

1819 S 22ND Ave
Suite 100
Bozeman, MT 59718-7070

Mailing address

1819 S 22ND Ave
Suite 100
Bozeman, MT 59718-7070
Phone (406) 451-9118

Other names 1

  • Acorn Pediatrics Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1462492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462492800000",
    "number": "1902252133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1819 S 22ND AVE",
            "address_2": "SUITE 100",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597187070",
            "telephone_number": "406-451-9118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1819 S 22ND AVE",
            "address_2": "SUITE 100",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597187070",
            "telephone_number": "406-451-9118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEILA M IDZERDA, MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-06",
        "last_updated": "2016-05-06",
        "status": "A",
        "authorized_official_last_name": "IDZERDA",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-451-9118",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MT",
            "license": "9597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Acorn Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bozeman, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.