NPIMap

Organization Active NPI

Northern Rockies Orthopaedics, PLLP

  • Clinic/Center
  • Missoula, MT
National Provider Identifier
1922008077
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
NORTHERN ROCKIES ORTHOPAEDICS, PLLP
Practice address
2740 South Avenue West
Suite 101
Missoula, MT 59804-5114
Phone
(406) 728-6101
Fax
(406) 721-3278
NPI assigned
Jul 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

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

Authorized official

Name
Justin A Jacobson, MDNPI 1578572129
Title
Partner
Phone
(406) 728-6101

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Clinic/Center 261Q00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

2740 South Avenue West
Suite 101
Missoula, MT 59804-5114

Mailing address

2740 South Ave W Ste 101
Missoula, MT 59804-5137
Phone (406) 728-6101

Other identifiers 1

IdentifierTypeStateIssuer
069155001OtherMTDMERC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040109000894 MT Part B Supplier - Clinic/Group Practice 6507766227 Receives reassigned benefits from 33 practitioners
Practice locations: Missoula, MT
O20100930023833 MT DME Supplier - Physician - Orthopedic/Orthopedic Surgery 6507766227 Practice locations: Missoula, MT

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

2875 Tina Ave
Ste 106
Missoula, MT 59808
Phone (406) 552-3587

2740 South Ave W
Ste 101
Missoula, MT 59804
Phone (406) 543-0617

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729555200000",
    "number": "1922008077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 SOUTH AVE W STE 101",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598045137",
            "telephone_number": "406-728-6101",
            "fax_number": "406-721-3278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 SOUTH AVENUE WEST",
            "address_2": "SUITE 101",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598045114",
            "telephone_number": "406-728-6101",
            "fax_number": "406-721-3278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ROCKIES ORTHOPAEDICS, PLLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-29",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "406-728-6101",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "069155001",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.