PROVIDENCE HEALTH & SERVICES MT — NPI 1902063688 (Board-Certified Cardiologist (Heart & Blood Vessel Specialist) in SUPERIOR, MT)

CMS-1500 Box 24J / 33a • NPI

1902063688

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

207RC0000X (CMS 06)

Board-Certified Cardiologist (Heart & Blood Vessel Specialist)

Box 32 Service Location & ZIP+4

1208 6TH AVE, SUPERIOR, MT, 59872-9618

✓ 9-Digit EDI 837 ZIP+4 (59872-9618)

Practice Phone & Referral Fax

(406) 822-4278

Fax: (406) 329-5606

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1902063688 (PROVIDENCE HEALTH & SERVICES MT) 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	`1902063688` (NPI-2 Organization / Facility)
Provider / Legal Name	PROVIDENCE HEALTH & SERVICES MT
Plain-English Specialty	Board-Certified Cardiologist (Heart & Blood Vessel Specialist) NUCC Code: `207RC0000X` (Internal Medicine, Cardiovascular Disease)
Certifying / Licensing Body	American Board of Internal Medicine — Cardiovascular Disease
Practice Location Address	1208 6TH AVE, SUPERIOR, MT, 59872-9618
Practice Telephone / Fax	Tel: (406) 822-4278 \| Fax: (406) 329-5606
Administrative Mailing Address	PO BOX 34439, SEATTLE, WA, 98124-1439
Enumeration & Last Sync	Enumerated: 2008-05-20 \| CMS Record Updated: 2011-06-22
Authorized Official	TERI MASTERS (RCM Operations Mgr)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1208 6TH AVE, SUPERIOR, MT, 59872-9618

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Plain-English Taxonomy & CMS Crosswalk (207RC0000X)

What Does Taxonomy Code 207RC0000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207RC0000X translates to:
"Board-Certified Cardiologist (Heart & Blood Vessel Specialist)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 06 (Physician/Cardiovascular Disease (Cardiology)) • CMS Code 11 (Physician/Internal Medicine)
Certifying / Accrediting Authority: American Board of Internal Medicine — Cardiovascular Disease
Clinical Scope: Chest pain (angina), palpitations, atrial fibrillation, heart murmurs, shortness of breath on exertion, resistant hypertension, or post-heart attack care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (PROVIDENCE HEALTH & SERVICES MT)

Typical CPT / Diagnostic Procedures:

Transthoracic Doppler Echocardiography (TTE — CPT 93306)
12-Lead Electrocardiogram (ECG) & Holter / Event Arrhythmia Monitoring
Exercise Treadmill & Myocardial Perfusion Nuclear Stress Testing
Diagnostic Coronary Angiography & Percutaneous Coronary Intervention (PCI)

Common Therapeutic Classes:

High-Intensity Statins (Atorvastatin, Rosuvastatin) & Ezetimibe
Beta-Blockers (Metoprolol Succinate, Carvedilol, Bisoprolol)
Sacubitril/Valsartan, Empagliflozin & Spironolactone (Heart Failure GDMT)
Apixaban, Rivaroxaban & Clopidogrel (Atrial Fibrillation & Stent Thrombosis Prevention)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`207RI0011X` — Internal Medicine, Interventional Cardiology Plain English: Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician)	State: N/A \| License: `Verified` \| Primary: Secondary
`207RP1001X` — Internal Medicine, Pulmonary Disease Plain English: Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician)	State: N/A \| License: `Verified` \| Primary: Secondary
`207RC0000X` — Internal Medicine, Cardiovascular Disease Plain English: Board-Certified Cardiologist (Heart & Blood Vessel Specialist)	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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PROVIDENCE HEALTH & SERVICES MT (NPI #1902063688)