Active NPI
Benjamin E. Montgomery, M.D.
- Family Medicine Physician
- Springfield, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036-109933
- Practice address
- 3220 Atlanta St Ste 100
Springfield, IL 62707-8801 - Phone
- (217) 545-8801
- Fax
- (217) 545-4444
- NPI assigned
- Sep 19, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036-109933 | IL | Primary |
Addresses
Primary practice location
3220 Atlanta St Ste 100
Springfield, IL 62707-8801
Mailing address
PO Box 19639
Springfield, IL 62794-9639
Phone (217) 545-8000
Other practice location 1
520 N 4th St
Springfield, IL 62702-5238
Phone (217) 545-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-109933 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Board of Trustees of Southern Illinois University | Current | Accepting new patients | |
| Board of Trustees of Southern Illinois University | Family Medicine | Current | Accepting new patients |
| Southern Illinois University | Past | Accepting new patients | |
| Passavant Memorial Area Hospital Association | Family Medicine | Past | Accepting new patients |
Locations
520 N 4th St
Springfield, IL 62702
Phone (217) 757-8100
3220 Atlanta St
Springfield, IL 62707
Phone (217) 588-2600
3220 Atlanta St
Ste 100
Springfield, IL 62707
Phone (217) 545-4968
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Primary Care Clinic/Center
- Springfield, IL
- NPI 1396097960
Family Medicine
-
- Federally Qualified Health Center (FQHC)
- Carbondale, IL
- NPI 1568210425
-
- Internal Medicine Physician
- Jacksonville, IL
- NPI 1760994040
Family Medicine
-
- Clinic/Center
- E Saint Louis, IL
- NPI 1306273776
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761091200000",
"number": "1083609747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19639",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627949639",
"telephone_number": "217-545-8000",
"fax_number": "844-470-2486"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3220 ATLANTA ST STE 100",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627078801",
"telephone_number": "217-545-8801",
"fax_number": "217-545-4444"
}
],
"practiceLocations": [
{
"address_1": "520 N 4th St",
"address_purpose": "LOCATION",
"city": "Springfield",
"state": "IL",
"postal_code": "627025238",
"country_code": "US",
"telephone_number": "217-545-8000",
"fax_number": "217-757-8161",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MONTGOMERY",
"first_name": "BENJAMIN",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-19",
"last_updated": "2025-10-22",
"certification_date": "2025-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036-109933",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; 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.