Kylie Gagnon Randall, OT is a medicare enrolled "Occupational Therapist" provider in Broadus, Montana. Her current practice location is
104 N Trautman Ave, Broadus, Montana. You can reach out to her office (for appointments etc.) via phone at
(406) 436-2646.
Kylie Gagnon Randall is licensed to practice in * (Not Available) (license number ) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1114428133.
Healthcare Provider's Profile
| Full Name | Kylie Gagnon Randall |
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| Gender | Female |
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| Speciality | Occupational Therapist |
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| Location | 104 N Trautman Ave, Broadus, Montana |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1114428133
- Provider Enumeration Date: 02/25/2018
- Last Update Date: 06/15/2021
Medicare PECOS Information:
- PECOS PAC ID: 0840551719
- Enrollment ID: I20180312000319
Medical Identifiers
Medical identifiers for Kylie Gagnon Randall such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1114428133 | NPI | - | NPPES |
| 5456 | Other | MT | OT LICENCE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 225X00000X | Occupational Therapist | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kylie Gagnon Randall allows following entities to bill medicare on her behalf.
| Provider Name | Bridger Orthopedics And Sports Medicine Pc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1750310926
PECOS PAC ID: 4587627096
Enrollment ID: O20041105000623 |
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| Provider Name | Powder River County |
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| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
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| Provider Identifiers | NPI Number: 1386611747
PECOS PAC ID: 2860543667
Enrollment ID: O20140205000654 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kylie Gagnon Randall is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Kylie Gagnon Randall, OT
3400 Stucky Rd,
Bozeman, MT 59718-7557
Ph: (406) 581-8300 | Kylie Gagnon Randall, OT
104 N Trautman Ave,
Broadus, MT 59317-7504
Ph: (406) 436-2646 |
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