Ty Montgomery, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

01047114A Issued in IN

Practice address

2451 Intelliplex Dr
Shelbyville, IN 46176-8580

Phone

(317) 392-3211

NPI assigned

Mar 8, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/333e9bbc-c795-477c-b297-aba3ff88fb23/

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.

• Early Detection Imaging, LLC

  • Diagnostic Radiology Physician
  • Lima, OH
  • NPI 1972664324
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615334400000",
    "number": "1003947276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 58",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458020058",
            "telephone_number": "866-942-0799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2451 INTELLIPLEX DR",
            "city": "SHELBYVILLE",
            "state": "IN",
            "postal_code": "461768580",
            "telephone_number": "317-392-3211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "TY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-08",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01047114A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000204615",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200286380",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmontgomery1003947276@direct.d4d.ihie.us",
            "affiliation": "N",
            "address_1": "2451 Intelliplex Dr",
            "city": "Shelbyville",
            "state": "IN",
            "country_code": "US",
            "postal_code": "461768580",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shuaib Mirani, DDS
• Kathryn S Mitchell
• Elizabeth June Fish Moats, FNP
• Anupama Mohanram, M.D.
• Flavien Ituka Mokeyo
• Christopher R Moore, PHARM.D.
• Tai Lynn Morrell, NP
• Abigail M Mueller
• Morgan Michelle Munson, FNP
• My Care at Home Home Health Care Services, LLC

• Diagnostic Radiology Physician in Shelbyville, IN
• Providers in Shelbyville, IN by specialty
• Diagnostic Radiology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.