Individual provider Active NPI

Shelby Montez

  • Psychiatric/Mental Health Nurse Practitioner
  • Toledo, OH
National Provider Identifier
1255106209
Registry record updated Jul 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
10814705-3102 Issued in OH
Practice address
1425 Starr Ave
Toledo, OH 43605-2456
Phone
(419) 693-0631
NPI assigned
Nov 20, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X 10814705-3102 OH
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 10814705-3102 OH Primary

Addresses

Primary practice location

1425 Starr Ave
Toledo, OH 43605-2456

Mailing address

1425 Starr Ave
Toledo, OH 43605-2456
Phone (419) 693-0631

Other identifiers 3

IdentifierTypeStateIssuer
260022408OtherUTRAILROAD MEDICARE
8760003008007MedicaidUT
000055266OtherUTMEDICARE PIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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 1

Enrollment IDStateProvider typePAC IDDetails
I20241030002551 OH Practitioner - Nurse Practitioner 1456884311 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Utah School of Medicine, 2024
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1425 Starr Ave
Toledo, OH 43605-2456

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10814705-3102OHMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Unison Behavioral Health Group, Inc. CurrentSince Sep 8, 2024 Accepting new patients
Unison Behavioral Health Group, Inc Past Accepting new patients

Locations

1084 S Main St
Ste A
Bowling Green, OH 43402
Phone (419) 352-4624

1425 Starr Ave
Toledo, OH 43605
Phone (419) 259-4506

544 E Woodruff Ave
Toledo, OH 43604
Phone (419) 214-4673

Organizations & group practices 2

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": "1700438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720915200000",
    "number": "1255106209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 STARR AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436052456",
            "telephone_number": "419-693-0631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 STARR AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436052456",
            "telephone_number": "419-693-0631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTEZ",
        "first_name": "SHELBY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-20",
        "last_updated": "2024-07-14",
        "certification_date": "2024-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "OH",
            "license": "10814705-3102",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "10814705-3102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "260022408",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8760003008007",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "000055266",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.