NPIMap

Organization Active NPI

Kessous & Kessous MD PC

Doing business as Montgomery Medical Clinic

  • Internal Medicine Physician
  • Gaithersburg, MD
National Provider Identifier
1447636048
Registry record updated Jul 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0070798 Issued in MD
Legal business name
KESSOUS & KESSOUS MD PC
Doing business as
Montgomery Medical Clinic
Practice address
800 S Frederick Ave
Ste 100
Gaithersburg, MD 20877-4150
Phone
(732) 768-8939
Fax
(301) 498-1347
NPI assigned
Aug 5, 2015
Reactivated
Jun 5, 2023
Last updated
Jul 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2023

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

Authorized official

Name
Dr. Efraim Kessous, MDNPI 1699983858
Title
Owner/MD
Phone
(732) 768-8939

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D0070798 MD Primary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X D0066523 MD

Addresses

Primary practice location

800 S Frederick Ave
Ste 100
Gaithersburg, MD 20877-4150

Mailing address

800 S Frederick Ave
Ste 100
Gaithersburg, MD 20877-4150
Phone (732) 768-8939

Other names 1

  • MONTGOMERY MEDICAL CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151016000824 DC Part B Supplier - Clinic/Group Practice 8426367384 Receives reassigned benefits from 6 practitioners
Practice locations: Gaithersburg, MD

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2113423Montgomery Medical Clinic800 S Frederick Ave Ste 110, Gaithersburg, MD 20877Certificate of waiverMay 22, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1438732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688515200000",
    "number": "1447636048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S FREDERICK AVE",
            "address_2": "STE 100",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208774150",
            "telephone_number": "732-768-8939",
            "fax_number": "301-498-1347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S FREDERICK AVE",
            "address_2": "STE 100",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208774150",
            "telephone_number": "732-768-8939",
            "fax_number": "301-498-1347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KESSOUS & KESSOUS MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-05",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "deactivation_date": "2023-05-04",
        "reactivation_date": "2023-06-05",
        "status": "A",
        "authorized_official_last_name": "KESSOUS",
        "authorized_official_first_name": "EFRAIM",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "732-768-8939",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0070798",
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "MD",
            "license": "D0066523",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MONTGOMERY MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MONTGOMERY MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.