Montgomery Medical Associates LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MONTGOMERY MEDICAL ASSOCIATES LLC

Practice address

542 N 3Rd St
Montgomery, IN 47558-5745

Phone

(812) 486-2842

NPI assigned

Sep 26, 2007

Last updated

May 6, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary Joan Holsopple

Title

Practice Manager

Phone

(812) 486-2842

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19031/brand/1/csg/1/fhir/r4

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Daviess County Hospital

  dba Daviess Community Hospital Montgomery Medical Clinic

  • Rural Health Clinic/Center
  • Montgomery, IN
  • NPI 1336959279

  Sold to, 2025-03-01

  CMS change of ownership

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Cheryl L Buss, NP

  • Adult Health Nurse Practitioner
  • Washington, IN
  • NPI 1124013321
  NPD (past)
• Carol A Miller, NP

  • Adult Health Nurse Practitioner
  • Linton, IN
  • NPI 1568674455
  NPD (past)

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

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620259200000",
    "number": "1023205754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102",
            "city": "MONTGOMERY",
            "state": "IN",
            "postal_code": "475580102",
            "telephone_number": "812-486-2842",
            "fax_number": "812-486-2784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "542 N 3RD ST",
            "city": "MONTGOMERY",
            "state": "IN",
            "postal_code": "475585745",
            "telephone_number": "812-486-2842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY MEDICAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-26",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A",
        "authorized_official_last_name": "HOLSOPPLE",
        "authorized_official_first_name": "MARY JOAN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "812-486-2842"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200864610A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deaconess Memorial Medical Center Inc (Country Health Center)
• Good Samaritan Family Health Center, Inc.
• Merle Ray Holsopple, MD
• Andre Thomas Knepp, LMHC
• Michele L Lloyd
• Prairie Creek Clinic
• Amber D Smith, D.C.
• Traylor Chiropractic LLC
• Adam Gregory Traylor, D.C.
• Victoria Wolf, NP

• Clinic/Center in Montgomery, IN
• Providers in Montgomery, IN by specialty
• Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.