Gwendolyn Elaine Montgomery, NURSE PRACTITIONER

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

RN176860 Issued in GA

Practice address

3962 Busby Mill CT
Ellenwood, GA 30294-2052

Phone

(404) 314-7295

NPI assigned

May 23, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Merit-based Incentive Payment System (MIPS)

Final score

96.48 of 100Reported as group

Quality

87.56

Promoting interoperability

100

Improvement activities

40

Cost

75.14

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Grady Memorial Hospital Corporation

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1114243813
  Medicare reassignment NPD
• Premier Healthcare Providers, LLC

  • Adult Health Nurse Practitioner
  • Ellenwood, GA
  • NPI 1326672734
  NPD (past) Authorized official
• Grady Memorial Hospital Corporation

  • Rehabilitation Hospital
  • Atlanta, GA
  • NPI 1336961119
  NPD
• Grady Memorial Hospital Corporation

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1992799050
  NPD (past)

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

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1629635859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3962 BUSBY MILL CT",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302942052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3962 BUSBY MILL CT",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302942052",
            "telephone_number": "404-314-7295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "GWENDOLYN",
        "middle_name": "ELAINE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-23",
        "last_updated": "2023-11-27",
        "certification_date": "2020-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "GA",
            "license": "RN176860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "MontgomeryAGACNP@gmail.com",
            "affiliation": "Y",
            "affiliationName": "Premier Healthcare Providers, LLC",
            "address_1": "3962 Busby Mill Ct",
            "city": "Ellenwood",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302942052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tremayne McMurray
• Ngassa Nchapada Menga Faith, NP
• Julia-Inez M Minnitee
• Tiffany Mitchell
• Monix Care
• Johanna Morn
• Renisha Morrow
• Deleon Mosely
• Joi Moses
• Moss Occupational Therapy Service LLC

• Acute Care Nurse Practitioner in Ellenwood, GA
• Providers in Ellenwood, GA by specialty
• Acute Care Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.