Active NPI
Tom Montgomery III
- Nursing Home Administrator
- Muskogee, OK
National Provider Identifier
1205225117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Home Administrator
- License
- 2286
- Practice address
- 1929 Betty Jane LN
Muskogee, OK 74403-1581 - Phone
- (918) 683-9407
- NPI assigned
- Jan 15, 2015
- 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 |
|---|---|---|---|---|
| Nursing Home Administrator | 376G00000X | 2286 | OK | Primary |
Addresses
Primary practice location
1929 Betty Jane LN
Muskogee, OK 74403-1581
Mailing address
1929 Betty Jane LN
Muskogee, OK 74403-1581
Phone (918) 683-9407
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200106120A | Medicaid | OK | |
| 375174 | Other | OK | MEDICARE PROVIDER ENROLLMENT |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2286 | OK | MD | Nursing Home Administrator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421280000000",
"number": "1205225117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1929 BETTY JANE LN",
"city": "MUSKOGEE",
"state": "OK",
"postal_code": "744031581",
"telephone_number": "918-683-9407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1929 BETTY JANE LN",
"city": "MUSKOGEE",
"state": "OK",
"postal_code": "744031581",
"telephone_number": "918-683-9407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTGOMERY",
"first_name": "TOM",
"name_prefix": "Mr.",
"name_suffix": "III",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-01-15",
"last_updated": "2015-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "376G00000X",
"taxonomy_group": "",
"desc": "Nursing Home Administrator",
"state": "OK",
"license": "2286",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200106120A",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PROVIDER ENROLLMENT",
"identifier": "375174",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Muskogee, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.