Montgomery Medical Associates LLC

Key facts

NPI

1023205754

Entity type

Organization (NPI type 2)

Primary specialty

Clinic/Center 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

Organization subpart

No

Authorized official

Name

Mary Joan Holsopple

Title

Practice Manager

Phone

(812) 486-2842

Change of ownership 1

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

• Daviess County Hospital Rural Health Clinic/Center · Montgomery, IN · NPI 1336959279
  CMS change of ownership Sold to · 2025-03-01

Practitioners 2

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

• 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)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Change-of-ownership history

National Provider Directory

Interoperability endpoints

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

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 6, 2021.

{
    "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": []
}

Other providers in Montgomery, IN

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• 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.
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• Adam Gregory Traylor, D.C.
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All providers in Montgomery, IN · Clinic/Center in Indiana