Montinique McCallum, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW005691 Issued in GA

Practice address

200 Crescent Center Pkwy Ste 150
Tucker, GA 30084-7047

Phone

(404) 365-0966

NPI assigned

Apr 29, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Montinique T Bentley Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1430265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1255718243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT RD NE",
            "address_2": "BLDG 9 1ST FLOOR",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303051736",
            "telephone_number": "404-365-0966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CRESCENT CENTER PKWY STE 150",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300847047",
            "telephone_number": "404-365-0966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCALLUM",
        "first_name": "MONTINIQUE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-29",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "200 Crescent Center Pkwy Ste 150",
            "city": "Tucker",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300847047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MONTINIQUE",
            "last_name": "BENTLEY",
            "middle_name": "T",
            "credential": "BS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kaleigh McAfee
• Samuel Nathaniel McAllister, M.D.
• William Hiroshi McAneny, FNP
• Marcia F. McBrayer, CFNP
• Ashley Nicole McCall, MD
• Jessica McCormick
• Steven J McCuiston, M.D.
• Christi Jenkins McDonald, DPT
• Sandra Joy McFarland, LCSW
• McGehee'S Medical Supply Company

• Clinical Social Worker in Tucker, GA
• Providers in Tucker, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.