Sydney Nicole Montgomery

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN259595 Issued in GA

Practice address

500 Medical Center Blvd Ste 250
Lawrenceville, GA 30046-3402

Phone

(770) 979-4700

Fax

(770) 979-1060

NPI assigned

Nov 19, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Nurse Practitioner

Education

University of Alabama School of Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Womens Group LLCGroup PAC ID 5991241135, 23 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sydney.montgomery@perinatalmed.gadirect.net

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.

• Northside Womens Group LLC

  • Obstetrics & Gynecology Physician
  • Lawrenceville, GA
  • NPI 1275380701
  Medicare reassignment Care Compare group NPD
• Atlanta Perinatal Associates

  • Maternal & Fetal Medicine Physician
  • Atlanta, GA
  • NPI 1104973064
  NPD
• CJC Health Solutions, LLC

  • Primary Care Nurse Practitioner
  • Snellville, GA
  • NPI 1063229466
  NPD
• Northside Womens Group LLC

  • Obstetrics & Gynecology Physician
  • Canton, GA
  • NPI 1245193358
  NPD
• Pagemed, LLC

  • Maternal & Fetal Medicine Physician
  • Macon, GA
  • NPI 1619274180
  NPD (past)
• St. Theresa'S OB/GYN Inc.

  • Obstetrics & Gynecology Physician
  • Snellville, GA
  • NPI 1619333713
  NPD (past)

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

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1447896956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 MEDICAL CENTER BLVD STE 250",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463402",
            "telephone_number": "770-979-4700",
            "fax_number": "770-979-1060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 MEDICAL CENTER BLVD STE 250",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463402",
            "telephone_number": "770-979-4700",
            "fax_number": "770-979-1060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2311 Henry Clower Blvd Ste E",
            "address_purpose": "LOCATION",
            "city": "Snellville",
            "state": "GA",
            "postal_code": "300787418",
            "country_code": "US",
            "telephone_number": "470-545-5551",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Medical Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300467694",
            "country_code": "US",
            "telephone_number": "678-312-4840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "550 Peachtree St NE Ste 1275",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303082240",
            "country_code": "US",
            "telephone_number": "404-872-3121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "SYDNEY",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-19",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WX0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Obstetric, Inpatient",
            "state": "GA",
            "license": "RN259595",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN259595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "15385033",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003256365",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aldemar Montero, M.D.
• Jacklyn J Montero, LCSW
• Latoya Venise Montfort, ACAGNP
• David James Montgomery Jr.
• Dea Rabon Montgomery, PH.D.
• Andrea Moody, LCSW
• Winfred Derrick Moody, MD
• Ann Marie Moon
• Michelle Moon
• Daneille Mooney, MSN, CNM

• Family Nurse Practitioner in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; 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.