Individual provider Active NPI

Leonard Darnell Montgomery, PA-C

  • Internal Medicine Physician
  • Fairmont, MN
National Provider Identifier
1114397742
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
8573 Issued in GA
Practice address
800 Medical Center Dr
Fairmont, MN 56031-4575
Phone
(507) 238-8100
NPI assigned
Sep 24, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0007177 MD
Physician Assistant 363A00000X 12181 MN
Surgical Physician Assistant 363AS0400X 6155 AZ
Internal Medicine Physician 207R00000X 8573 GA Primary

Addresses

Primary practice location

800 Medical Center Dr
Fairmont, MN 56031-4575

Mailing address

1850 Town Center Pkwy Ste 309
Reston, VA 20190-3300
Phone (703) 705-4180

Other practice location 1

7503 Surratts Rd
Clinton, MD 20735-3358
Phone (301) 877-4509

Other practice location 2

1850 Town Center Pkwy Ste 309
Reston, VA 20190-3300
Phone (703) 705-4180

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD, VA, GA4 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20190909000954 DC Practitioner - Physician Assistant 3274841457 Reassigns benefits to 5 organizations
I20200831002112 MD Practitioner - Physician Assistant 3274841457 Reassigns benefits to 1 organization
I20230323000556 VA Practitioner - Physician Assistant 3274841457 Reassigns benefits to 1 organization
I20240129000484 GA Practitioner - Physician Assistant 3274841457 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Emory Clinic IncGroup PAC ID 8820901408, 3,507 clinicians
Urgent Specialty Associates PLLCGroup PAC ID 7618235995, 56 clinicians
Emory Medical Care Foundation IncGroup PAC ID 4981501814, 1,003 clinicians

Practice addresses (Care Compare)

1365 Clifton Rd NE
Atlanta, GA 30322-1013
Phone (404) 778-7525

1850 Town Ctr Pkwy
Reston, VA 20190-3204
Phone (703) 689-9000

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3031
Phone (404) 616-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.48 of 100Reported as group
Quality
94.83
Promoting interoperability
100
Improvement activities
40
Cost
73.42

Merit-based Incentive Payment System (MIPS)

Final score
93.24 of 100Reported as group
Quality
73.72
Promoting interoperability
100
Improvement activities
40
Cost
75.22

Merit-based Incentive Payment System (MIPS)

Final score
92.64 of 100Reported as group
Quality
97.21
Promoting interoperability
100
Improvement activities
40
Cost
78.25

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
8573GAMDInternal Medicine Physician
C0007177MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Associates, PA Emergency Medicine CurrentSince Nov 1, 2019 Accepting new patients
Emergency Medicine Associates P.a., P.C. Internal Medicine CurrentSince Nov 1, 2019 Accepting new patients
Washington Hospital Center Corp CurrentSince Jul 21, 2019 Accepting new patients
Emory Medical Care Foundation Inc Emergency Medicine CurrentSince Jan 29, 2024 Accepting new patients
The Emory Clinic Inc Internal Medicine CurrentSince Jan 29, 2024 Accepting new patients
Medstar Urgent Care LLC CurrentSince Aug 15, 2020 Accepting new patients
WHC Emerg Phys CurrentSince Mar 1, 2020 Accepting new patients
Emory Medical Care Foundation Inc CurrentSince Jan 29, 2024 Accepting new patients
Medstar Urgent Care, LLC CurrentSince Aug 15, 2020 Accepting new patients

Locations

110 Irving St NW
Washington, DC 20010
Phone (202) 877-2000

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

2201 Henderson Mill Rd NE
Ste 160
Atlanta, GA 30345
Phone (404) 251-2193

6317 York Rd
Baltimore, MD 21212
Phone (443) 777-6890

7503 Surratts Rd
Clinton, MD 20735
Phone (301) 868-8000

3064 Waldorf Market Pl
Waldorf, MD 20603
Phone (301) 932-5960

11915 Georgia Ave
Wheaton, MD 20902
Phone (301) 942-4505

1701 N George Mason Dr
Arlington, VA 22205
Phone (703) 558-5000

1850 Town Center Pkwy
Ste 309
Reston, VA 20190
Phone (703) 705-4180

1850 Town Center Pkwy
Reston, VA 20190
Phone (703) 478-0922

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1443052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1114397742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 TOWN CENTER PKWY STE 309",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201903300",
            "telephone_number": "703-705-4180",
            "fax_number": "571-926-8943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MEDICAL CENTER DR",
            "city": "FAIRMONT",
            "state": "MN",
            "postal_code": "560314575",
            "telephone_number": "507-238-8100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7503 Surratts Rd",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "MD",
            "postal_code": "207353358",
            "country_code": "US",
            "telephone_number": "301-877-4509",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1850 Town Center Pkwy Ste 309",
            "address_purpose": "LOCATION",
            "city": "Reston",
            "state": "VA",
            "postal_code": "201903300",
            "country_code": "US",
            "telephone_number": "703-705-4180",
            "fax_number": "571-926-8943",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "LEONARD",
        "middle_name": "DARNELL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-24",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0007177",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12181",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "6155",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "8573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairmont, MN

Sources for this page

Verify at the official NPI Registry.