PONDEROSA HEALING WATERS — NPI 1366308140 (Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical in ST IGNATIUS, MT)

CMS-1500 Box 24J / 33a • NPI

1366308140

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

1041C0700X (CMS 80)

Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical

Box 32 Service Location & ZIP+4

109 1ST AVE, ST IGNATIUS, MT, 59865-7748

✓ 9-Digit EDI 837 ZIP+4 (59865-7748)

Practice Phone & Referral Fax

(406) 880-7305

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1366308140 (PONDEROSA HEALING WATERS) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1366308140` (NPI-2 Organization / Facility)
Provider / Legal Name	PONDEROSA HEALING WATERS
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical NUCC Code: `1041C0700X` (Social Worker, Clinical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	109 1ST AVE, ST IGNATIUS, MT, 59865-7748
Practice Telephone / Fax	Tel: (406) 880-7305
Administrative Mailing Address	PO BOX 548, RONAN, MT, 59864-0548
Enumeration & Last Sync	Enumerated: 2025-12-24 \| CMS Record Updated: 2026-04-28
Authorized Official	ANGELA EVANS (LAC, SWLC, owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

109 1ST AVE, ST IGNATIUS, MT, 59865-7748

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Plain-English Taxonomy & CMS Crosswalk (1041C0700X)

What Does Taxonomy Code 1041C0700X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1041C0700X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 80 (Licensed Clinical Social Worker)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Social Worker, Clinical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (PONDEROSA HEALING WATERS)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`261QM1300X` — Clinic/Center, Multi-Specialty Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QR0405X` — Clinic/Center, Rehabilitation, Substance Use Disorder Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261Q00000X` — Clinic/Center Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`1041C0700X` — Social Worker, Clinical Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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PONDEROSA HEALING WATERS (NPI #1366308140)