NPIMap

Individual provider Active NPI

Elizabeth Montgomery, P.A

  • Medical Physician Assistant
  • Edmond, OK
National Provider Identifier
1659642163
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2082 Issued in OK
Practice address
4509 Integris Pkwy Ste 200
Edmond, OK 73034-8696
Phone
(405) 657-3950
Fax
(405) 471-0040
NPI assigned
Jan 16, 2012
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2082 OK Primary

Addresses

Primary practice location

4509 Integris Pkwy Ste 200
Edmond, OK 73034-8696

Mailing address

5300 N Independence Ave
Suite 280
Oklahoma City, OK 73112-5556
Phone (405) 657-3950

Other names 1

  • Elizabeth Bodine Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20120515000596 OK Practitioner - Physician Assistant 9335302199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians

Practice addresses (Care Compare)

3400 NW Expressway
Suite 500
Oklahoma City, OK 73112-4492
Phone (405) 945-4589

4801 Integris Pkwy
Edmond, OK 73034-8864
Phone (405) 657-3150

4833 Integris Pkwy
Edmond, OK 73034-8864

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Integris Ambulatory Care C Orporation Past Accepting new patients
Summit Medical Center Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: emontgomery12213@direct.integrisok.com

Organizations & group practices 3

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 8

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": "1326672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1659642163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 N INDEPENDENCE AVE",
            "address_2": "SUITE 280",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731125556",
            "telephone_number": "405-657-3950",
            "fax_number": "405-471-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4509 INTEGRIS PKWY STE 200",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730348696",
            "telephone_number": "405-657-3950",
            "fax_number": "405-471-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "ELIZABETH",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-16",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "2082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "BODINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Edmond, OK

Sources for this page

Verify at the official NPI Registry.