NPIMap

Individual provider Active NPI

Patrick Joshua O'Brien, MD

  • Vascular Surgery Physician
  • Missoula, MT
National Provider Identifier
1942414040
Registry record updated Jun 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
29427 Issued in MT
Practice address
500 W Broadway St Ste 320
Missoula, MT 59802-4031
Phone
(406) 329-5615
NPI assigned
May 9, 2007
Last updated
Jun 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 29427 MT Primary

Addresses

Primary practice location

500 W Broadway St Ste 320
Missoula, MT 59802-4031

Mailing address

PO Box 12
Liberty Lake, WA 99019-0012
Phone (866) 747-2455

Other practice location 1

902 N Orange St
Missoula, MT 59802-2928
Phone (406) 329-5736

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address pobrien373833@wm.providencedirect.org Direct
Direct Messaging Address pobrien373833@wm.providencedirect.org Direct

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
I20140220000147 MT Practitioner - Vascular Surgery 3476721317 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
JC Edwards School of Medicine, Marshall University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians

Practice addresses (Care Compare)

500 W Broadway St
SPH Inpatient Phy Services
Missoula, MT 59802-4096
Phone (406) 543-7271

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Leg revascularization (restoring blood flow)1-10
Removal of tissue12

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29427MTMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt Current Accepting new patients
Providence Health & Services Mt CurrentSince Mar 1, 2014 Accepting new patients
Providence Health & Services Mt CurrentSince Mar 1, 2014 Accepting new patients
Providence Health & Services Mt Past Accepting new patients

Locations

1200 Westwood Dr
Hamilton, MT 59840
Phone (406) 363-2211

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

500 W Broadway St
Ste 320
Missoula, MT 59802
Phone (406) 329-2945

902 N Orange St
Missoula, MT 59802
Phone (406) 327-3300

Organizations & group practices 4

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": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1942414040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190012",
            "telephone_number": "866-747-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST STE 320",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024031",
            "telephone_number": "406-329-5615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "902 N Orange St",
            "address_purpose": "LOCATION",
            "city": "Missoula",
            "state": "MT",
            "postal_code": "598022928",
            "country_code": "US",
            "telephone_number": "406-329-5736",
            "fax_number": "406-329-2991",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "PATRICK",
        "middle_name": "JOSHUA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MT",
            "license": "29427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pobrien373833@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 W Broadway St Ste 320",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pobrien373833@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "902 N Orange St",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598022928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.