NPIMap

Individual provider Active NPI

Crystal A Montgomery, F.N.P.

  • Family Nurse Practitioner
  • Maplewood, MN
National Provider Identifier
1578898391
Registry record updated Oct 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2059 Issued in MN
Practice address
1600 Saint Johns Blvd Ste 101
Maplewood, MN 55109-1190
Phone
(651) 232-5354
NPI assigned
Oct 13, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health & Wellness Coach 171400000X 2059 MN
Family Nurse Practitioner 363LF0000X 2059 MN Primary

Addresses

Primary practice location

1600 Saint Johns Blvd Ste 101
Maplewood, MN 55109-1190

Mailing address

15820 Dakota St NW
Andover, MN 55304-2329
Phone (574) 298-7797

Other practice location 1

11269 Jefferson Hwy N
Champlin, MN 55316-3123
Phone (763) 236-0600

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cmontgomery567868@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20110413000554 MN Practitioner - Nurse Practitioner 0749324515 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Healtheast Medical Research Institute Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Feb 4, 2017 Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Oct 1, 2021 Accepting new patients
Healtheast Medical Research Institute CurrentSince Feb 4, 2017 Accepting new patients
Allina Health System CurrentSince Dec 31, 2022 Accepting new patients
Allina Health System Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

1600 Saint Johns Blvd
Ste 101
Maplewood, MN 55109
Phone (651) 232-5354

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

1700 University Ave W
Fl 1
Saint Paul, MN 55104
Phone (651) 232-2002

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

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 and National Provider Directory roles.

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1255392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634860800000",
    "number": "1578898391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15820 DAKOTA ST NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553042329",
            "telephone_number": "574-298-7797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SAINT JOHNS BLVD STE 101",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091190",
            "telephone_number": "651-232-5354"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11269 Jefferson Hwy N",
            "address_purpose": "LOCATION",
            "city": "Champlin",
            "state": "MN",
            "postal_code": "553163123",
            "country_code": "US",
            "telephone_number": "763-236-0600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "CRYSTAL",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-13",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "MN",
            "license": "2059",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "2059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmontgomery567868@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "11269 Jefferson Hwy N",
            "city": "Champlin",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553163123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maplewood, MN

Sources for this page

Verify at the official NPI Registry.