Active NPI
Gordon James Montgomery, M.D.
- Specialist
- Chula Vista, CA
National Provider Identifier
1144226234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- G31591
- Practice address
- 835 Third Ave Ste a
Chula Vista, CA 91911-1352 - Phone
- (619) 425-7755
- Fax
- (619) 425-2138
- NPI assigned
- Jun 23, 2005
- Reactivated
- Apr 5, 2006
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | G31591 | CA | Primary |
Addresses
Primary practice location
835 Third Ave Ste a
Chula Vista, CA 91911-1352
Mailing address
835 Third Ave Ste a
Chula Vista, CA 91911-1352
Phone (619) 425-7755
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G5315910 | Medicaid | CA | |
| 00G315911 | Medicaid | CA | |
| WG31591D | Other | CA | MEDICARE PIN # (R) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G31591 | CA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scripps Health | Current | Accepting new patients |
Interoperability endpoints
- gmontgomery81354@scrippshlth.medalliesdirect.net
Organizations & group practices 1
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.
-
dba Scripps Hospital Medical Services
- General Acute Care Hospital
- San Diego, CA
- NPI 1487928891
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598400000000",
"number": "1144226234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "835 THIRD AVE STE A",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919111352",
"telephone_number": "619-425-7755",
"fax_number": "619-425-2138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "835 THIRD AVE STE A",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919111352",
"telephone_number": "619-425-7755",
"fax_number": "619-425-2138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTGOMERY",
"first_name": "GORDON",
"middle_name": "JAMES",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-23",
"last_updated": "2020-08-26",
"certification_date": "2020-08-26",
"deactivation_date": "2006-04-05",
"reactivation_date": "2006-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "G31591",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G5315910",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G315911",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PIN # (R)",
"identifier": "WG31591D",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chula Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.