Roy Montgomery, PA-C – Physician Assistant

Key facts

NPI: 1275927857
Entity type: Individual (NPI type 1)
Primary specialty: Physician Assistant 363A00000X
License: 6012 (AZ)
Practice address: 1750 E Arica Rd
Eloy, AZ 85131
Phone: (801) 243-3675
NPI assigned: Mar 23, 2015
Sex: Male
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physician Assistant	363A00000X	6012	AZ	Yes

Addresses

Primary practice location

1750 E Arica Rd
Eloy, AZ 85131

Mailing address

4600 S Mill Ave
Tempe, AZ 85282-6757
Phone (480) 305-2888

Other practice location 1

1750 E Arica Rd
Eloy, AZ 85131-1215
Phone (801) 243-3675

Other practice location 2

1750 E Arica Rd
Eloy, AZ 85131-1215
Phone (801) 243-3675

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 12, 2018.

{
    "created_epoch": "1427068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531353600000",
    "number": "1275927857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 S MILL AVE",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852826757",
            "telephone_number": "480-305-2888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 E ARICA RD",
            "city": "ELOY",
            "state": "AZ",
            "postal_code": "85131",
            "telephone_number": "801-243-3675"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1750 E Arica Rd",
            "address_purpose": "LOCATION",
            "city": "Eloy",
            "state": "AZ",
            "postal_code": "851311215",
            "country_code": "US",
            "telephone_number": "801-243-3675",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1750 E Arica Rd",
            "address_purpose": "LOCATION",
            "city": "Eloy",
            "state": "AZ",
            "postal_code": "851311215",
            "country_code": "US",
            "telephone_number": "801-243-3675",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "ROY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-23",
        "last_updated": "2018-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eloy, AZ

All providers in Eloy, AZ · Physician Assistant in Arizona

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2018. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.