Gary Dale Montgomery, PA-C
Individual provider Active NPI Physician Assistant · Everett, WA
NPI 1104299601 · NPPES record last updated May 20, 2025
Key facts
- NPI
- 1104299601
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA60577634 (WA)
- Practice address
- 12800 Bothell Everett Hwy
Ste a
Everett, WA 98208-6642 - Phone
- (425) 316-5150
- Fax
- (425) 903-3142
- NPI assigned
- Nov 5, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 19
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- East Phillips County Hospital District
Rural Physicians Group-Pannu PLLC
Practice addresses (Care Compare)
1001 E Johnson St
Holyoke, CO 80734-1854
Phone 97085422412130
1140 N State St
Saint Ignace, MI 49781-1048
Phone (906) 643-7999
301 N Main St
Sheridan, MI 48884-9235
Phone (989) 291-3261
Hospital & facility affiliations
- Melissa Memorial Hospital
- Sheridan Community Hospital
- Mackinac Straits Hospital and Health Center
- Sheridan Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in WA, CO, MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170329001345 | WA | Practitioner - Physician Assistant | 1456636745 | Reassigns benefits to 1 organization |
| I20240222003138 | CO | Practitioner - Physician Assistant | 1456636745 | Reassigns benefits to 5 organizations |
| I20250402002025 | MI | Practitioner - Physician Assistant | 1456636745 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Poudre Valley Medical Group, LLC | Current |
Accepting new patients | |
| East Phillips County Hospital District | Current |
Accepting new patients | |
| Providence Health & Services - Washington | Current |
Accepting new patients | |
| Providence Health & Services- Washington | Current |
Accepting new patients | |
| East Phillips County Hospital District | Past | Accepting new patients | |
| Mackinac Straits Health System Inc | Past | Accepting new patients | |
| Sheridan Community Hospital | Past | Accepting new patients | |
| East Phillips County Hospital District | Past | Accepting new patients | |
| Mackinac Straits Health System Inc | Past | Accepting new patients | |
| East Phillips County Hospital District | Past | Accepting new patients | |
| East Phillips County Hospital District | Past | Accepting new patients | |
| Summit Urgent Care, P.S. | Past | Accepting new patients |
Locations
4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260
5965 Firestone Blvd
Bldg B
Firestone, CO 80504
Phone (720) 652-7055
2127 E Harmony Rd
Ste 140
Fort Collins, CO 80528
Phone (970) 207-4800
2819 35th Ave
Greeley, CO 80634
Phone (970) 652-2801
5881 W 16th St
Ste A
Greeley, CO 80634
Phone (970) 313-2700
1001 E Johnson St
Holyoke, CO 80734
Phone (970) 854-2241
4846 Larimer Pkwy
Bldg 1
Johnstown, CO 80534
Phone (970) 624-2830
2970 Arapahoe Rd
Lafayette, CO 80026
Phone (303) 460-6010
2101 Main St
Longmont, CO 80501
Phone (720) 745-8020
2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412
1159 Eagle Dr
Loveland, CO 80537
Phone (970) 219-5223
221 E 29th St
Ste 102
Loveland, CO 80538
Phone (970) 224-3636
1700 13th St
Everett, WA 98201
Phone (425) 252-0895
12800 Bothell Everett Hwy
Ste A
Everett, WA 98208
Phone (425) 316-5150
4112 Harbour Pointe Blvd SW
Ste 100
Mukilteo, WA 98275
Phone (425) 347-6330
Interoperability endpoints
- gary.montgomery.1@15466.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601013078 | MI | |
| Physician Assistant | 363A00000X | PA60577634 | WA | Yes |
Addresses
Primary practice location
12800 Bothell Everett Hwy
Ste a
Everett, WA 98208-6642
Mailing address
PO Box 827
Bellevue, WA 98009-0827
Phone (425) 563-6258
Other practice location 1
1140 N State St
Saint Ignace, MI 49781-1048
Phone (303) 390-1940
Other providers in Everett, WA
- Megan Monroe
- Trinh Ngoc Monroe
- Chelsea Carty Monsees
- Franco Monteza
- Bonnie Michele Montgomery
- Kevin Farrell Montgomery
- Ana Maria Montoya-Alm
- Brenda Montoya
- Valarie Moon
- Bridget Mooney
All providers in Everett, WA · Physician Assistant in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.