NPIMap

Individual provider Active NPI

Mark L. Montgomery, M.D.

  • Vascular & Interventional Radiology Physician
  • Temple, TX
National Provider Identifier
1366403347
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
J6603 Issued in TX
Practice address
2401 S 31St St
Temple, TX 76508-0001
Phone
(254) 724-2111
NPI assigned
Mar 30, 2006
Last updated
Jan 25, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X J6603 TX
Vascular & Interventional Radiology Physician 2085R0204X J6603 TX Primary

Addresses

Primary practice location

2401 S 31St St
Temple, TX 76508-0001

Mailing address

PO Box 844658
Dallas, TX 75284-4658

Other practice location 1

2201 S Clear Creek Rd
Killeen, TX 76549-4110
Phone (254) 526-7523

Other identifiers 4

IdentifierTypeStateIssuer
1050882-01OtherTXCSHCN
87433YOtherTXBLUE SHIELD
300115737OtherTXRR/MEDICARE
1050882-02MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmontgomery11490@direct.sw.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100112000083 TX Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 0345381406 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional RadiologyAlso: Diagnostic Radiology
Education
Texas a & M University System, HSC, College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scott and White ClinicGroup PAC ID 8123923604, 2,426 clinicians

Practice addresses (Care Compare)

100 Medical Pkwy
Lakeway, TX 78738-5621
Phone (512) 571-5000

1300 E Polk St
Baylor Scott and White Clinic Burnet
Burnet, TX 78611-2136
Phone (512) 715-6400

1605 S 31St St
Baylor Scott and White Center for Dia
Temple, TX 76508-0001
Phone (254) 215-0100

1701 E Pflugerville Pkwy
Baylor Scott and White Clinic Pflug
Pflugerville, TX 78660-8990
Phone (512) 259-6000

200 Medical Pkwy
Lakeway, TX 78738-1794

2401 S 31 St
Temple, TX 76508-0001
Phone (254) 724-2459

2401 S 31St St BLDG
35 Baylor Scott and White Roney Bone and
Temple, TX 76508-0001
Phone (254) 724-2663

2600 E Pflugerville Pkwy
BLDG 2
Pflugerville, TX 78660-5998
Phone (512) 654-6500

425 University Blvd
Round Rock, TX 78665-1053
Phone (512) 509-0200

5245 W Hwy 290
Baylor Scott and White Medical Center Austi
Austin, TX 78735-8963
Phone (512) 654-2100

5251 W Hwy 290
Baylor Scott and White Clinic Austin Oak Hi
Austin, TX 78735-8963
Phone (512) 654-3000

5251 W Hwy 290 100
Baylor Scott and White Cancer and Infusion Ce
Austin, TX 78735-8963
Phone (512) 654-4319

810 W U Ave
Temple, TX 76508-0001
Phone (254) 724-2585

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
J6603TXMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scott & White Clinic Diagnostic Radiology CurrentSince Jul 1, 2000 Accepting new patients
Btdi JV, LLP CurrentSince Feb 11, 2019 Accepting new patients
Btdi JV, LLP CurrentSince Oct 14, 2016 Accepting new patients
Btdi JV, LLP CurrentSince Aug 1, 2023 Accepting new patients
Scott & White Clinic Diagnostic Radiology CurrentSince Jul 1, 2000 Accepting new patients
Btdi JV, LLP CurrentSince Mar 1, 2023 Accepting new patients
Btdi JV, LLP CurrentSince Sep 28, 2022 Accepting new patients
Healthtexas Provider Network Past Accepting new patients
Scott & White Hospital - Taylor Past Accepting new patients

Locations

5251 W Highway 290
Austin, TX 78735
Phone (512) 654-3000

101 Lafferty Ave
Cameron, TX 76520
Phone (254) 605-1100

1280 Arrington Rd
Ste 200
College Station, TX 77845
Phone (979) 207-6550

2201 Clear Creek Rd
Killeen, TX 76549
Phone (254) 519-8185

1701 E Pflugerville Pkwy
Pflugerville, TX 78660
Phone (512) 259-6000

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

Interoperability endpoints

  • Direct secure messaging: mmontgomery11490@direct.sw.org

Ownership & related parties

All facility ownership & control disclosures 20

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Baylor Scott & White Medical Center - TempleTemple, TX, CCN 450054 Hospital Operational/Managerial Control Nov 1, 2015
Baylor Scott & White Medical Center - TaylorTaylor, TX, CCN 451374 Hospital Operational/Managerial Control Jul 1, 2015
Baylor Scott & White Continuing Care HospitalTemple, TX, CCN 452105 Hospital Operational/Managerial Control Nov 1, 2015
Baylor Scott & White Medical Center - Round RockRound Rock, TX, CCN 670034 Hospital Operational/Managerial Control Nov 1, 2015
Baylor Scott & White Medical Center TaylorTaylor, TX, CCN 45Z374 Hospital Operational/Managerial Control Jul 1, 2015
Baylor Scott & White Medical Center - College StationCollege Station, TX, CCN 670088 Hospital Operational/Managerial Control Nov 1, 2015
Baylor Scott & White Medical Center - Marble FallsMarble Falls, TX, CCN 670108 Hospital Operational/Managerial Control Jul 1, 2015
Baylor Scott & White Medical Center - PflugervillePflugerville, TX, CCN 670128 Hospital Operational/Managerial Control Dec 1, 2018
Baylor Scott & White Medical Center - BudaBuda, TX, CCN 670131 Hospital Operational/Managerial Control Sep 28, 2019
Baylor Scott & White Medical Center - AustinAustin, TX, CCN 670136 Hospital Corporate Officer Jan 15, 2020
Baylor Scott & White Continuing Care HospitalTemple, TX, CCN 455069 Skilled nursing facility Operational/Managerial Control Aug 9, 2017
Baylor Scott & White Hospice - TempleTemple, TX, CCN 451691 Hospice Operational/Managerial Control Nov 1, 2015
Baylor Scott & White Hospice - WacoWaco, TX, CCN 451569 Hospice Operational/Managerial Control Jul 1, 2015
Baylor Scott & White - the Brenham ClinicBrenham, TX, CCN 673942 Rural health clinic Corporate Director Sep 17, 2018
Baylor Scott & White Clinic - Horseshoe BayHorseshoe Bay, TX, CCN 458839 Rural health clinic Operational/Managerial Control Nov 1, 2015
Baylor Scott & White Clinic - KingslandKingsland, TX, CCN 458686 Rural health clinic Operational/Managerial Control Nov 1, 2015
Baylor Scott & White Clinic - Johnson CityJohnson City, TX, CCN 673417 Rural health clinic Operational/Managerial Control Sep 1, 2019
Baylor Scott & White Clinic - San SabaSan Saba, TX, CCN 458799 Rural health clinic Operational/Managerial Control Nov 1, 2015
Baylor Scott & White Clinic - Marble FallsMarble Falls, TX, CCN 458693 Rural health clinic Operational/Managerial Control Nov 1, 2015
Baylor Scott & White Clinic - LlanoLlano, TX, CCN 453413 Rural health clinic Operational/Managerial Control Sep 1, 2019

Owned or controlled facilities with NPI records 22

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 22

Organizations & group practices 9

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1366403347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 S 31ST ST",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765080001",
            "telephone_number": "254-724-2111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2201 S Clear Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Killeen",
            "state": "TX",
            "postal_code": "765494110",
            "country_code": "US",
            "telephone_number": "254-526-7523",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "MARK",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-30",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "J6603",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "TX",
            "license": "J6603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN",
            "identifier": "1050882-01",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "87433Y",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR/MEDICARE",
            "identifier": "300115737",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1050882-02",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmontgomery11490@direct.sw.org",
            "affiliation": "N",
            "address_1": "2401 S 31st St",
            "city": "Temple",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765080001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Temple, TX

Sources for this page

Verify at the official NPI Registry.