NPIMap

Organization Active NPI

Montgomery Radiology Associates, PA

  • Specialist
  • Montgomery, AL
National Provider Identifier
1023046604
Registry record updated Mar 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MONTGOMERY RADIOLOGY ASSOCIATES, PA
Practice address
2055 Normandie Dr
Suite 108
Montgomery, AL 36111-2732
Phone
(334) 288-4624
Fax
(334) 280-3628
NPI assigned
Jun 30, 2006
Organization subpart
No

Practitioners 75

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 75

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, AZ, FL, CA, TN, CO, NJ, NC, VA, NY10 enrollments

Enrollment records 10

Enrollment IDStateProvider typePAC IDDetails
O20040108000123 AL Part B Supplier - Clinic/Group Practice 2961301999 Receives reassigned benefits from 64 practitioners
Practice locations: Jackson, AL; Leeds, AL; Luverne, AL; Monroeville, AL; Montgomery, AL; Ozark, AL; Prattville, AL; Troy, AL…
O20230126002614 AZ Part B Supplier - Clinic/Group Practice 2961301999 Receives reassigned benefits from 1 practitioner
Practice locations: Scottsdale, AZ
O20231106000070 FL Part B Supplier - Clinic/Group Practice 2961301999 Receives reassigned benefits from 5 practitioners
Practice locations: Wimauma, FL; Sarasota, FL; Miami Lakes, FL; Miami, FL; Gulf Breeze, FL
O20231114001541 CA Part B Supplier - Clinic/Group Practice 2961301999 Receives reassigned benefits from 2 practitioners
Practice locations: Carlsbad, CA; Los Angeles, CA
O20240208001747 TN Part B Supplier - Clinic/Group Practice 2961301999 Receives reassigned benefits from 1 practitioner
Practice locations: Nashville, TN
O20240318002865 CO Part B Supplier - Clinic/Group Practice 2961301999 Receives reassigned benefits from 2 practitioners
Practice locations: Evergreen, CO; Grand Junction, CO; Loveland, CO
O20250128003531 NJ Part B Supplier - Clinic/Group Practice 2961301999 Receives reassigned benefits from 1 practitioner
Practice locations: Short Hills, NJ
O20250324001975 NC Part B Supplier - Clinic/Group Practice 2961301999 Receives reassigned benefits from 1 practitioner
Practice locations: Highlands, NC
O20250404001575 VA Part B Supplier - Clinic/Group Practice 2961301999 Receives reassigned benefits from 1 practitioner
Practice locations: Leesburg, VA
O20260411000091 NY Part B Supplier - Clinic/Group Practice 2961301999 Receives reassigned benefits from 1 practitioner
Practice locations: East Amherst, NY

National Provider Directory

National Provider Directory

Locations

987 Drayton Ave
Elba, AL 36323
Phone (334) 322-1730

NPPES NPI Registry

Updated by the provider on Mar 22, 2023

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

Authorized official

Name
Mark D Laurent
Title
Ceo
Phone
(334) 288-4624

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

2055 Normandie Dr
Suite 108
Montgomery, AL 36111-2732

Mailing address

2055 Normandie Dr Ste 200
Montgomery, AL 36111-2732
Phone (334) 269-6337

Other identifiers 1

IdentifierTypeStateIssuer
000060159MedicaidAL

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1023046604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2055 NORMANDIE DR STE 200",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361112732",
            "telephone_number": "334-269-6337",
            "fax_number": "334-834-0657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 NORMANDIE DR",
            "address_2": "SUITE 108",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361112732",
            "telephone_number": "334-288-4624",
            "fax_number": "334-280-3628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY RADIOLOGY ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A",
        "authorized_official_last_name": "LAURENT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "334-288-4624"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000060159",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.