NPIMap

Individual provider Active NPI

Stephen Montgomery, MD

  • Family Medicine Physician
  • Pontotoc, MS
National Provider Identifier
1699735159
Registry record updated Feb 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10719 Issued in MS
Practice address
345 Highway 15 N
Pontotoc, MS 38863-1105
Phone
(662) 489-7430
Fax
(662) 489-7938
NPI assigned
Mar 27, 2006
Last updated
Feb 21, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2011

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 10719 MS Primary

Addresses

Primary practice location

345 Highway 15 N
Pontotoc, MS 38863-1105

Mailing address

345 Highway 15 N
Pontotoc, MS 38863-1105
Phone (662) 489-7430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20090217000419 MS Practitioner - Family Practice 4486719978 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pontotoc Health Services, Inc.Group PAC ID 6002895356, 18 clinicians
Tri-Vista Rehab, Inc.Group PAC ID 0345390308, shared by 3 NPIs, 26 clinicians

Practice addresses (Care Compare)

345 Hwy 15 N
Pontotoc Medical
Pontotoc, MS 38863-3311
Phone (662) 489-7430

90 Clark Ave a
Tupelo, MS 38804-2801

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pontotoc Health Services, Inc. CurrentSince Sep 1, 2008 Accepting new patients
North Mississippi Medical Center Current Accepting new patients
Pontotoc Health Services, Inc. Current Accepting new patients
Pontotoc Health Services, Inc. CurrentSince Sep 1, 2008 Accepting new patients
Sunshine Health Care, Inc Past Accepting new patients
Pontotoc LTC, Inc Past Accepting new patients
Pontotoc Health Services, Inc. Past Accepting new patients

Locations

202 Main St
Ecru, MS 38841
Phone (662) 489-4345

400 Doctors Dr
New Albany, MS 38652
Phone (662) 534-5036

176 S Main St
Pontotoc, MS 38863
Phone (601) 489-5510

345 Highway 15 N
Pontotoc, MS 38863
Phone (662) 489-7430

Interoperability endpoints

  • Direct secure messaging: stevemontgomery@nmhs.medalliesdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sunshine Health Care, IncPontotoc, MS, CCN 255319 Skilled nursing facility Adp of the SNF Jul 1, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298246400000",
    "number": "1699735159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 HIGHWAY 15 N",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388631105",
            "telephone_number": "662-489-7430",
            "fax_number": "662-489-7938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 HIGHWAY 15 N",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388631105",
            "telephone_number": "662-489-7430",
            "fax_number": "662-489-7938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "STEPHEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-27",
        "last_updated": "2011-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "10719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontotoc, MS

Sources for this page

Verify at the official NPI Registry.