Individual provider Active NPI

Penny Cummins Montcalm, NP

  • Family Nurse Practitioner
  • Mangham, LA
National Provider Identifier
1376877241
Registry record updated Jun 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RNO077152 APO4877 Issued in LA
Practice address
261 Highway 132
Mangham, LA 71259-5269
Phone
(318) 248-2807
Fax
(318) 248-2967
NPI assigned
Sep 25, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RNO077152 APO4877 LA Primary

Addresses

Primary practice location

261 Highway 132
Mangham, LA 71259-5269

Mailing address

130 Desiard St Ste 355
Monroe, LA 71201-7363
Phone (318) 807-7875

Other identifiers 1

IdentifierTypeStateIssuer
2458132MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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

Enrollment IDStateProvider typePAC IDDetails
I20100730000650 LA Practitioner - Nurse Practitioner 0446383269 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Foot and Ankle Clinics, LLCGroup PAC ID 7911125968, 3 clinicians

Practice addresses (Care Compare)

3601 Desiard St
Monroe, LA 71203-4352
Phone (318) 397-1574

Merit-based Incentive Payment System (MIPS)

Final score
89.48 of 100Reported as group
Quality
73.04
Improvement activities
40
Cost
73.78

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RNO077152 APO4877LAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Foot and Ankle Clinics, LLC CurrentSince Apr 9, 2019 Accepting new patients
Affinity Health Group, LLC CurrentSince Oct 10, 2017 Accepting new patients
Specialty Extended Care Hospital of Monroe LLC CurrentSince Jun 26, 2010 Accepting new patients
The Foot and Ankle Clinics, LLC CurrentSince Apr 9, 2019 Accepting new patients
Specialty Extended Care Hospital of Monroe, LLC CurrentSince Jun 26, 2010 Accepting new patients
Affinity Health Group, LLC CurrentSince Oct 10, 2017 Accepting new patients

Locations

261 Highway 132
Mangham, LA 71259
Phone (318) 248-2807

3601 Desiard St
Monroe, LA 71203
Phone (318) 397-1574

130 Desiard St
Ste 355
Monroe, LA 71201
Phone (318) 807-7875

2408 Broadmoor Blvd
Ste 2
Monroe, LA 71201
Phone (318) 807-0525

2408 Broadmoor Blvd
Monroe, LA 71201
Phone (318) 410-0002

309 Jackson St
Fl 7
Monroe, LA 71201
Phone (318) 327-4600

1325 Louisville Ave
Monroe, LA 71201
Phone (318) 807-1500

2309 Arkansas Rd
West Monroe, LA 71291
Phone (318) 397-1574

Interoperability endpoints

  • Direct secure messaging: penny.montcalm.1@8881.direct.athenahealth.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1253836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560297600000",
    "number": "1376877241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 DESIARD ST STE 355",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017363",
            "telephone_number": "318-807-7875",
            "fax_number": "318-812-6603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "261 HIGHWAY 132",
            "city": "MANGHAM",
            "state": "LA",
            "postal_code": "712595269",
            "telephone_number": "318-248-2807",
            "fax_number": "318-248-2967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTCALM",
        "first_name": "PENNY",
        "middle_name": "CUMMINS",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-25",
        "last_updated": "2019-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "RNO077152 APO4877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2458132",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mangham, LA

Sources for this page

Verify at the official NPI Registry.