Mary Jean Montgomery, LCDCII, A.A.S.

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

111042 Issued in OH

Practice address

732 Beckman Street
Dayton, OH 45410-2165

Phone

(937) 301-5678

NPI assigned

Jun 6, 2018

Last updated

Jun 6, 2018By the provider in NPPES

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 identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Associate of Applied Science

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nova Behavioral Health, Inc

  • Substance Abuse Rehabilitation Facility
  • Dayton, OH
  • NPI 1548217748
  NPD (past)
• Nova Behavioral Health, Inc.

  • Substance Abuse Rehabilitation Facility
  • Dayton, OH
  • NPI 1164782017
  NPD (past)

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

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528243200000",
    "number": "1285126052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 BECKMAN STREET",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454102165",
            "telephone_number": "937-253-1680",
            "fax_number": "937-253-1337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 BECKMAN STREET",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454102165",
            "telephone_number": "937-301-5678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "MARY",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "LCDCII, A.A.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-06",
        "last_updated": "2018-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "OH",
            "license": "111042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "600540025",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "106S00000X",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Montgomery Preparatory Academy
• Candace Montgomery, PEER SUPPORT/CDCA
• Jamie Montgomery, CDCA
• Jasmine Montgomery
• Kiyana Montgomery
• Mya Montgomery
• Rebecca Montgomery, MSCCC,SLP
• Michael Patrick Montz
• Taylor M Monus
• Mariela Monzalvo

• Behavior Technician in Dayton, OH
• Providers in Dayton, OH by specialty
• Behavior Technician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.