NPIMap

Individual provider Active NPI

Douglas P Wadle, MD

  • Internal Medicine Physician
  • Livingston, MT
National Provider Identifier
1922115393
Registry record updated Jul 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
10363 Issued in MT
Practice address
320 Alpenglow Lane
Livingston, MT 59047
Phone
(406) 823-6414
Fax
(406) 823-6287
NPI assigned
Aug 23, 2006
Last updated
Jul 27, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 10363 MT Primary

Addresses

Primary practice location

320 Alpenglow Lane
Livingston, MT 59047

Mailing address

320 Alpenglow Lane
Livingston, MT 59047
Phone (406) 823-6414

Other identifiers 2

IdentifierTypeStateIssuer
000094765OtherMTBLUECROSSBLUESHIELD
0074681MedicaidMT

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
I20040123000823 MT Practitioner - Internal Medicine 8123920758 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Colorado School of Medicine, Denver, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Livingston HealthcareGroup PAC ID 5991613598, 66 clinicians

Practice addresses (Care Compare)

320 Alpenglow LN
Livingston, MT 59047-8506
Phone (406) 222-3541

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
74.05 of 100Reported as group
Quality
59.76
Promoting interoperability
99
Improvement activities
40
Cost
54.58

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10363MTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Livingston Healthcare CurrentSince Oct 4, 2004 Accepting new patients
Livingston Healthcare CurrentSince Oct 4, 2004 Accepting new patients

Locations

104 Centennial Dr
Livingston, MT 59047
Phone (406) 222-0030

104 Centennial Dr
Ste 103
Livingston, MT 59047
Phone (406) 222-0030

320 Alpenglow Ln
Livingston, MT 59047
Phone (406) 222-3541

Interoperability endpoints

  • Direct secure messaging: douglas.wadle@livingstonhealthcare.cernerdirect.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Livingston Healthcare Shields Valley ClinicWilsall, MT, CCN 273427 Rural health clinic Corporate Director Jan 25, 2006

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595808000000",
    "number": "1922115393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 ALPENGLOW LANE",
            "city": "LIVINGSTON",
            "state": "MT",
            "postal_code": "59047",
            "telephone_number": "406-823-6414",
            "fax_number": "406-823-6287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 ALPENGLOW LANE",
            "city": "LIVINGSTON",
            "state": "MT",
            "postal_code": "59047",
            "telephone_number": "406-823-6414",
            "fax_number": "406-823-6287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADLE",
        "first_name": "DOUGLAS",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MT",
            "license": "10363",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD",
            "identifier": "000094765",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0074681",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Livingston, MT

Sources for this page

Verify at the official NPI Registry.