Bruce A Montgomery, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

34004231M Issued in OH

Practice address

5757 Monclova Rd
Ste 24
Maumee, OH 43537-1863

Phone

(419) 897-2270

Fax

(419) 897-2290

NPI assigned

Nov 21, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: brucemontgomery@hhproviders.allscriptsdirect.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.

• Sandusky Wellness Center Inc

  • Chiropractor
  • Sandusky, OH
  • NPI 1356486187
  NPD (past)
• Sandusky Wellness DME LLC

  • Durable Medical Equipment & Medical Supplies
  • Sandusky, OH
  • NPI 1134534225
  NPD (past)

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304294400000",
    "number": "1689657934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5757 MONCLOVA RD",
            "address_2": "STE 24",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371863",
            "telephone_number": "419-897-2270",
            "fax_number": "419-897-2290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5757 MONCLOVA RD",
            "address_2": "STE 24",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371863",
            "telephone_number": "419-897-2270",
            "fax_number": "419-897-2290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "BRUCE",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2011-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34004231M",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000142183",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARAMOUNT HEALTH CARE",
            "identifier": "02111",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0904927",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RAILROAD MED",
            "identifier": "080155060",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dayna F Mohammadione, MD
• Anastasia Molina
• Peggy Moll, LPN
• Monclova Road Pediatrics
• Brittney Mong, RBT
• Al Moore
• Arianne M Moore
• Bailey Nicole Moore, CDCA
• Delores Regina Moore, LICDC
• Rachel M Moore

• Family Medicine Physician in Maumee, OH
• Providers in Maumee, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.