NPIMap

Individual provider Active NPI

Stefan L Montgomery, MD

  • Family Medicine Physician
  • Spartanburg, SC
National Provider Identifier
1437135944
Registry record updated Feb 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
27277 Issued in SC
Practice address
853 N Church St
Suite 510
Spartanburg, SC 29303-3098
Phone
(864) 560-6193
Fax
(864) 560-1510
NPI assigned
Dec 16, 2005
Last updated
Feb 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 27277 SC Primary
Sports Medicine (Family Medicine) Physician 207QS0010X 27277 SC

Addresses

Primary practice location

853 N Church St
Suite 510
Spartanburg, SC 29303-3098

Mailing address

PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304

Other identifiers 3

IdentifierTypeStateIssuer
AA05373365OtherSCMEDICARE PIN
P01556670OtherSCRAILROAD MEDICARE
272779MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address smontgomery40705@direct-srhs.et0939.epichosted.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20040810000333 SC Practitioner - Family PracticePractitioner - Sports Medicine 0446222558 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
University of South Carolina School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spartanburg Medical CenterGroup PAC ID 3072425297, 1,060 clinicians

Practice addresses (Care Compare)

101 E Wood St
Spartanburg, SC 29303-3040
Phone (864) 560-6193

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Spartanburg Medical Center Current Accepting new patients
Spartanburg Medical Center Family Medicine CurrentSince Sep 13, 2014 Accepting new patients
Spartanburg Medical Center CurrentSince Sep 13, 2014 Accepting new patients
Pelham Medical Center CurrentSince May 29, 2020 Accepting new patients
Pelham Medical Center Family Medicine CurrentSince May 29, 2020 Accepting new patients
Spartanburg Medical Center Past Accepting new patients
Spartanburg Medical Center Past Accepting new patients

Locations

250 Westmoreland Rd
Greer, SC 29651
Phone (864) 530-2108

101 E Wood St
Spartanburg, SC 29303
Phone (864) 560-1915

101 E Wood St
Ste 300
Spartanburg, SC 29303
Phone (864) 560-6554

853 N Church St
Ste 510
Spartanburg, SC 29303
Phone (864) 560-1558

Interoperability endpoints

  • Direct secure messaging: smontgomery40705@direct-srhs.et0939.epichosted.com

Organizations & group practices 7

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 4

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": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612137600000",
    "number": "1437135944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743070",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743070",
            "telephone_number": "864-560-4304",
            "fax_number": "864-560-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 N CHURCH ST",
            "address_2": "SUITE 510",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033098",
            "telephone_number": "864-560-6193",
            "fax_number": "864-560-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "STEFAN",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-16",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "27277",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "SC",
            "license": "27277",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "AA05373365",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01556670",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272779",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smontgomery40705@direct-srhs.et0939.epichosted.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "smontgomery40705@direct-srhs.et0939.epichosted.com",
            "address_1": "853 N Church St",
            "address_2": "Suite 510",
            "city": "Spartanburg",
            "state": "SC",
            "country_code": "US",
            "postal_code": "293033098",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

Verify at the official NPI Registry.