Montgomery Bernard Douglas, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

054868 Issued in CT

Practice address

Uconn Medical Group
263 Farmington Ave
Farmington, CT 06030-0001

Phone

(860) 679-4477

Fax

(860) 679-4474

NPI assigned

Jun 8, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

JS Weill Medical College, Cornell University, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University Physicians of Brooklyn, Inc.Group PAC ID 0749192284, 174 clinicians

University Hospital of Brooklyn Suny Downstate Health Sciences UniversGroup PAC ID 7113318122, 91 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Suny/Downstate University Hospital of Brooklyn Hospital, Brooklyn, NY, CCN 330350

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: mdouglas10724@direct.med.uchc.edu
• Direct secure messaging: montgomerydouglas@sunydmc.allscriptsdirect.net

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.

• University Hospital of Brooklyn Suny Downstate Health Sciences Univers

  • Family Medicine Physician
  • Brooklyn, NY
  • NPI 1396318986
  Medicare reassignment Care Compare group NPD
• University Physicians of Brooklyn, Inc.

  • Family Medicine Physician
  • Brooklyn, NY
  • NPI 1366506271
  Medicare reassignment Care Compare group NPD
• University Hospital of Brooklyn Suny Downstate Health Sciences Univers

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Brooklyn, NY
  • NPI 1528027414
  NPD
• University Physicians of Brooklyn

  • Family Medicine Physician
  • Brooklyn, NY
  • NPI 1124075049
  NPD
• University of Connecticut Health Center

  • Clinical Medical Laboratory
  • Farmington, CT
  • NPI 1427031293
  NPD (past)
• CMC Housestaff

  • Family Medicine Physician
  • Elmhurst, NY
  • NPI 1063572212
  NPD (past)
• University Hospital of Brooklyn Suny Downstate Health Sciences Univers

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1639179328
  NPD (past)
• University Physicians of Brooklyn, Inc

  • Anesthesiology Physician
  • Brooklyn, NY
  • NPI 1104878180
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• University Hospital of Brooklyn Suny Downstate Health Sciences Univers

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1639179328
  Care Compare affiliation

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468540800000",
    "number": "1114120839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UCONN MEDICAL GROUP",
            "address_2": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "860-679-4477",
            "fax_number": "860-679-4474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UCONN MEDICAL GROUP",
            "address_2": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "860-679-4477",
            "fax_number": "860-679-4474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "MONTGOMERY",
        "middle_name": "BERNARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-08",
        "last_updated": "2016-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "171089",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "054868",
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "CT",
            "license": "054868",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01141015",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monica Sonia Kaur Dosanjh, B.SC, DMD
• Sara Naureen Dost, M.D.
• Anthony Dotur, MD
• Jenna Nicole Doty, PA-C
• Kareem Douglas
• Deborah Downes, RD
• Sarah Downs, MPH, CHES
• Herbert E Downton Ramos, MC
• Avery Doyle, M.S., CCC/SLP
• Nathan Doyle

• Family Medicine Physician in Farmington, CT
• Providers in Farmington, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.