Individual provider Active NPI

Stuart M Montenegro, DO

  • Family Medicine Physician
  • Scott Afb, IL
National Provider Identifier
1689308223
Registry record updated Jan 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036176648 Issued in IL
Practice address
310 W Losey St
Scott Afb, IL 62225-5250
Phone
(618) 256-9355
NPI assigned
Jul 11, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036176648 IL Primary

Addresses

Primary practice location

310 W Losey St
Scott Afb, IL 62225-5250

Mailing address

3 Saint Elizabeth Blvd Ste 4000
O Fallon, IL 62269-1284
Phone (618) 222-4600

Other practice location 1

3 Saint Elizabeth Blvd Ste 4000
O Fallon, IL 62269-1284
Phone (618) 222-4600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220921000264 NE Order and Referring Only - Family PracticePractitioner - Family Practice 3173908514

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2866NEMDMental Health Counselor
036176648ILMDFamily Medicine Physician

Interoperability endpoints

  • Direct secure messaging: stuart.montenegro.1@9559.direct.athenahealth.com

NPI Registry JSON

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

{
    "created_epoch": "1657497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768867200000",
    "number": "1689308223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 SAINT ELIZABETH BLVD STE 4000",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691284",
            "telephone_number": "618-222-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-9355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Saint Elizabeth Blvd Ste 4000",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "IL",
            "postal_code": "622691284",
            "country_code": "US",
            "telephone_number": "618-222-4600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTENEGRO",
        "first_name": "STUART",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-11",
        "last_updated": "2026-01-20",
        "certification_date": "2026-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036176648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scott Afb, IL

Sources for this page

Verify at the official NPI Registry.