NPIMap

Individual provider Active NPI

Marci Rae Mangold, PAC

  • Physician Assistant
  • Kalispell, MT
National Provider Identifier
1932262052
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
310 Issued in MT
Practice address
160 Heritage Way Ste 202
Kalispell, MT 59901-3127
Phone
(406) 752-8433
Fax
(406) 756-6768
NPI assigned
Dec 19, 2006
Last updated
Nov 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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 310 MT Primary

Addresses

Primary practice location

160 Heritage Way Ste 202
Kalispell, MT 59901-3127

Mailing address

160 Heritage Way Ste 202
Kalispell, MT 59901-3127
Phone (406) 752-8433

Other identifiers 1

IdentifierTypeStateIssuer
4301947MedicaidMT

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krmcmedicalrecords@krhdirect.org Kalispell Regional Medical Center Inc

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
I20031212000626 MT Practitioner - Physician Assistant 7416854021 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kalispell Obstetrics and Gynecology PLLCGroup PAC ID 4789570318, 4 clinicians

Practice addresses (Care Compare)

165 Commons Loop
Suite E
Kalispell, MT 59901-1919
Phone (406) 752-5252

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
310MTMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kalispell Regional Medical Center, Inc CurrentSince Sep 14, 2011 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Glacier Regional Pathology, LTD. Current Accepting new patients
Kalispell Regional Medical Center Inc CurrentSince Sep 14, 2011 Accepting new patients
Western Montana Clinic PC Current Accepting new patients

Locations

304 Osloski Rd
Eureka, MT 59917
Phone (406) 297-2438

160 Heritage Way
Ste 202
Kalispell, MT 59901
Phone (406) 752-8433

350 Heritage Way
Ste 2100
Kalispell, MT 59901
Phone (406) 257-8992

70 Village Loop Rd
Kalispell, MT 59901
Phone (406) 752-8877

500 W Broadway St
Missoula, MT 59802
Phone (406) 327-1918

Interoperability endpoints

  • Direct secure messaging: krmcmedicalrecords@krhdirect.org

Organizations & group practices 6

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 7

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": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1932262052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 HERITAGE WAY STE 202",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013127",
            "telephone_number": "406-752-8433",
            "fax_number": "406-756-6768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 HERITAGE WAY STE 202",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013127",
            "telephone_number": "406-752-8433",
            "fax_number": "406-756-6768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGOLD",
        "first_name": "MARCI",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2023-11-27",
        "certification_date": "2020-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4301947",
            "state": "MT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "address_1": "160 Heritage Way Ste 202",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599013127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kalispell, MT

Sources for this page

Verify at the official NPI Registry.