Individual provider Active NPI

Tinika A Montgomery, M.D.

  • Nephrology Physician
  • Fargo, ND
National Provider Identifier
1295895738
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
0101243122 Issued in VA
Practice address
2101 Elm St N
Fargo, ND 58102-2417
Phone
(701) 239-3700
Fax
(701) 451-7891
NPI assigned
Dec 12, 2006
Last updated
Aug 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 312009 NY
Nephrology Physician 207RN0300X 054523 CT
Nephrology Physician 207RN0300X 75296 GA
Nephrology Physician 207RN0300X 0101243122 VA Primary

Addresses

Primary practice location

2101 Elm St N
Fargo, ND 58102-2417

Mailing address

2101 Elm St N
Fargo, ND 58102-2417
Phone (701) 239-3700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, CT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160712001158 GA Practitioner - Nephrology 6406148451 Reassigns benefits to 1 organization
I20201222002869 CT Practitioner - Nephrology 6406148451 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.36 of 100Reported as group
Quality
77.36
Promoting interoperability
100
Improvement activities
40
Cost
74.27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
312009NYMDLicensed Practical Nurse
054523CTMDNephrology Physician
75296GAMDNephrology Physician
0101243122VAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yale University CurrentSince Dec 10, 2020 Accepting new patients
Yale University CurrentSince Dec 10, 2020 Accepting new patients
Kidney Specialists of Savannah, P. C. CurrentSince Jul 1, 2016 Accepting new patients
Kidney Specialists of Savannah PC Nephrology CurrentSince Jul 1, 2016 Accepting new patients

Locations

50 Division St
New Haven, CT 06511
Phone (203) 785-2140

800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140

260 Long Ridge Rd
Stamford, CT 06902
Phone (203) 863-3000

500 E 66th St
Savannah, GA 31405

5303 Montgomery St
Savannah, GA 31405
Phone (912) 352-1354

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IJFIBA

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1295895738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 ELM ST N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581022417",
            "telephone_number": "701-239-3700",
            "fax_number": "701-451-7891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 ELM ST N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581022417",
            "telephone_number": "701-239-3700",
            "fax_number": "701-451-7891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "TINIKA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-12",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "312009",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CT",
            "license": "054523",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "75296",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "VA",
            "license": "0101243122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.