Tara Lyn Montgomery-Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601004621 Issued in MI

Practice address

90 N Michigan Ave
Coldwater, MI 49036-1527

Phone

(248) 860-4634

NPI assigned

May 5, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Tara Lyn Montgomery Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375

  Physician Assistant

  Medicare reassignment NPD
• Complexcare Medical Group Midwest H PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1457144933
  Medicare reassignment
• Ella E M Brown Charitable Circle

  • Psychiatry Physician
  • Marshall, MI
  • NPI 1366591794
  Medicare reassignment
• Ella E M Brown Charitable Circle

  • Diagnostic Radiology Physician
  • Marshall, MI
  • NPI 1043660467

  Physician Assistant

  NPD
• Ella E M Brown Charitable Circle

  • Medical Physician Assistant
  • Homer, MI
  • NPI 1518159169
  NPD

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1366490005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41850 W 11 MILE RD STE 202",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483751857",
            "telephone_number": "248-860-4634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 N MICHIGAN AVE",
            "city": "COLDWATER",
            "state": "MI",
            "postal_code": "490361527",
            "telephone_number": "248-860-4634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY-JOHNSON",
        "first_name": "TARA",
        "middle_name": "LYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-05",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "MONTGOMERY",
            "middle_name": "LYN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Julia Helen Miller, LLBSW
• Rachel Michelle Miller, PA-C
• Timothy James Miller, D.O.
• Zoey Mobley
• Michael Damian Moleski, MD
• Janet Louise Moon, RN
• Moore Counseling Services, Inc.
• Brenee' D Moore, LMSW
• Emma Lauren Moore
• John Alexander Moore, D.O.

• Physician Assistant in Coldwater, MI
• Providers in Coldwater, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.