NPIMap

Individual provider Active NPI

Sophia Raelyn Vivant, PA-C

  • Physician Assistant
  • Missoula, MT
National Provider Identifier
1912675216
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
129044 Issued in MT
Practice address
700 W Kent Ave
Missoula, MT 59801-6772
Phone
(406) 541-3277
Fax
(406) 541-3811
NPI assigned
Sep 1, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 129044 MT Primary

Addresses

Primary practice location

700 W Kent Ave
Missoula, MT 59801-6772

Mailing address

700 W Kent Ave
Missoula, MT 59801-6772
Phone (406) 541-3277

Other practice location 1

2760 Elizabeth Warren Ave Ste A
Butte, MT 59701-3979
Phone (406) 792-1250

Other practice location 2

120 S 5th St Ste 104
Hamilton, MT 59840-2798
Phone (406) 363-3366

Other names 1

  • Sophia Peterson Former name

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
I20230921000993 MT Practitioner - Physician Assistant 5991159287 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rocky Mountain Ear Nose and Throat Center PCGroup PAC ID 3678472099, 20 clinicians

Practice addresses (Care Compare)

700 W Kent Ave
Missoula, MT 59801-6772
Phone (406) 541-3937

Hospital & facility affiliations

  • St. Patrick Hospital Hospital, Missoula, MT, CCN 270014
  • Community Medical Center Hospital, Missoula, MT, CCN 270023
  • St James Hospital Hospital, Butte, MT, CCN 270017
  • Deer Lodge Medical Center Hospital, Deer Lodge, MT, CCN 271314
  • Clark Fork Valley Hospital Hospital, Plains, MT, CCN 271323

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
129044MTMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: speterson2994089@wm.providencedirect.org

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.

Hospital & facility affiliations 9

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": "1630454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1912675216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 W KENT AVE",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598016772",
            "telephone_number": "406-541-3277",
            "fax_number": "406-541-3811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W KENT AVE",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598016772",
            "telephone_number": "406-541-3277",
            "fax_number": "406-541-3811"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2760 Elizabeth Warren Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Butte",
            "state": "MT",
            "postal_code": "597013979",
            "country_code": "US",
            "telephone_number": "406-792-1250",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 S 5th St Ste 104",
            "address_purpose": "LOCATION",
            "city": "Hamilton",
            "state": "MT",
            "postal_code": "598402798",
            "country_code": "US",
            "telephone_number": "406-363-3366",
            "fax_number": "406-541-3811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIVANT",
        "first_name": "SOPHIA",
        "middle_name": "RAELYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-01",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "129044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SOPHIA",
            "last_name": "PETERSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.