Individual provider Active NPI

Elizabeth Kim Montgomery, AU.D., CCC-A

  • Audiologist
  • Slidell, LA
National Provider Identifier
1174782015
Registry record updated May 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
3610 Issued in LA
Practice address
2050 Gause Blvd E Ste 200
Slidell, LA 70461-5425
Phone
(985) 646-4400
Fax
(985) 646-4408
NPI assigned
Jun 5, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist-Hearing Aid Fitter 237600000X 3610 LA
Audiologist 231H00000X 3610 LA Primary

Addresses

Primary practice location

2050 Gause Blvd E Ste 200
Slidell, LA 70461-5425

Mailing address

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816-6038
Phone (985) 646-4400

Other practice location 1

1111 Medical Center Blvd Ste S630
Marrero, LA 70072-3194
Phone (504) 340-6976

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080922000251 LA Practitioner - Qualified Audiologist 3173690922 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Our Lady of the Lake Physician Group LLCGroup PAC ID 4587849781, 637 clinicians

Practice addresses (Care Compare)

2050 Gause Blvd E
Suite 200
Slidell, LA 70461-5425
Phone (225) 647-6636

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3610LAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of the Lake Physician Group, LLC CurrentSince May 5, 2025 Accepting new patients
Our Lady of the Lake Physician Group LLC Current Accepting new patients
Culicchia Neurological Clinic, LLC CurrentSince Jan 1, 2015 Accepting new patients
Our Lady of the Lake Physician Group LLC CurrentSince May 5, 2025 Accepting new patients
Our Lake of the Lake Head and Neck Ce Past Accepting new patients

Locations

7777 Hennessy Blvd
Ste 409
Baton Rouge, LA 70808
Phone (225) 765-1765

7777 Hennessy Blvd
Ste 709
Baton Rouge, LA 70808
Phone (225) 765-7735

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011

804 Heavens Dr
Ste 101
Mandeville, LA 70471
Phone (985) 201-5550

1111 Medical Center Blvd
Ste S630
Marrero, LA 70072
Phone (504) 349-6336

1111 Medical Center Blvd
Ste S750
Marrero, LA 70072

502 Leontine St
New Orleans, LA 70115
Phone (504) 934-8321

2050 Gause Blvd E
Ste 200
Slidell, LA 70461
Phone (504) 646-4400

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746403200000",
    "number": "1174782015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5959 S SHERWOOD FOREST BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708166038",
            "telephone_number": "985-646-4400",
            "fax_number": "225-765-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 GAUSE BLVD E STE 200",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704615425",
            "telephone_number": "985-646-4400",
            "fax_number": "985-646-4408"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 Medical Center Blvd Ste S630",
            "address_purpose": "LOCATION",
            "city": "Marrero",
            "state": "LA",
            "postal_code": "700723194",
            "country_code": "US",
            "telephone_number": "504-340-6976",
            "fax_number": "504-349-6786",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "ELIZABETH",
        "middle_name": "KIM",
        "credential": "AU.D., CCC-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-05",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "LA",
            "license": "3610",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "LA",
            "license": "3610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Slidell, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.