Emmett Fulcher Montgomery, MD
Individual provider Active NPI Family Medicine Physician · Davidson, NC
NPI 1356337646 · NPPES record last updated Dec 20, 2022
Key facts
- NPI
- 1356337646
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 35242 (NC)
- Practice address
- 104 Knox CT Ste 100
Davidson, NC 28036-0590 - Phone
- (704) 892-5454
- Fax
- (704) 892-5858
- NPI assigned
- Sep 22, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Avance Care PA
Practice addresses (Care Compare)
104 Knox CT
Suite 100
Davidson, NC 28036-0590
Phone (704) 892-5454
7510 Ramble Way
Suite 107
Raleigh, NC 27616-4305
Phone (919) 747-3033
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100826000378 | NC | Practitioner - Family Practice | 8820078736 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avance Care, PA | Current |
Accepting new patients | |
| Afc Urgent Care and Family Care of WNC, PLLC | Current |
Accepting new patients | |
| Advanced Healthcare | Family Medicine | Past | Accepting new patients |
Locations
10102 Johnston Rd
Charlotte, NC 28210
Phone (704) 247-6578
14001 E Independence Blvd
Ste C
Indian Trail, NC 28079
Phone (704) 247-6598
7510 Ramble Way
Ste 107
Raleigh, NC 27616
Phone (919) 277-8880
1025 Peerless Xing NW
Cleveland, TN 37312
Phone (423) 476-5990
Interoperability endpoints
- emmett.montgomery.1@14667.direct.athenahealth.com
- emmett.montgomery.1@29681.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35242 | NC | Yes |
Addresses
Primary practice location
104 Knox CT Ste 100
Davidson, NC 28036-0590
Mailing address
PO Box 4329
Davidson, NC 28036-4329
Phone (704) 892-5454
Other practice location 1
435 E Statesville Ave
Mooresville, NC 28115-2598
Phone (704) 663-5056
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8960083 | Medicaid | NC |
Other providers in Davidson, NC
- Elizabeth Eiserman Miller
- Modernday Wellness PLLC
- Bryn Mohn
- Moliver Chiropractic, PLLC
- Seth Loren Moliver
- Rebecca Piles Montgomery
- Lauren Mook
- Kathleen McMahon Morris
- Ms Rapid Answers, LLC
- Tara Renee Muma
All providers in Davidson, NC · Family Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.