NPIMap

Individual provider Active NPI

Carolyn A Montgomery, NP

  • Gerontology Nurse Practitioner
  • Buffalo, NY
National Provider Identifier
1720053416
Registry record updated Apr 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
F340627 Issued in NY
Practice address
40 La Riviere Dr Ste 201
Buffalo, NY 14202-4344
Phone
(716) 893-1010
Fax
(716) 893-1002
NPI assigned
Feb 17, 2006
Last updated
Apr 26, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X F340627 NY Primary

Addresses

Primary practice location

40 La Riviere Dr Ste 201
Buffalo, NY 14202-4344

Mailing address

40 La Riviere Dr Ste 201
Buffalo, NY 14202-4344
Phone (716) 893-1010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20060306000396 NY Practitioner - Nurse Practitioner 0749296358 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Mobile Medical Care PCGroup PAC ID 8426575325, 97 clinicians
Mobile Physician Services PLLCGroup PAC ID 8325360290, 104 clinicians

Practice addresses (Care Compare)

Buffalo, NY 14202
Phone (716) 893-1010

2365 Union Rd
Cheektowaga, NY 14227-2234
Phone (716) 668-8100

4650 Southwestern Blvd
Hamburg, NY 14075-1939
Phone (716) 648-2450

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F340627NYMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mobile Physician Services PLLC CurrentSince Oct 1, 2016 Accepting new patients
Physician Mobile Medical Care PC CurrentSince Apr 1, 2025 Accepting new patients
Horizon Health Services Inc PastSince Sep 1, 2019 Accepting new patients
Mobile Primary Care Family Nurse Practitioners, PLLC Past Accepting new patients
Elder Medical Services PC PastSince Aug 1, 2004 Accepting new patients

Locations

40 La Riviere Dr
Ste 140
Buffalo, NY 14202

40 La Riviere Dr
Ste 201
Buffalo, NY 14202
Phone 7168931010210

40 La Riviere Dr
Ste 201A
Buffalo, NY 14202
Phone 7168931010221

50 Lakefront Blvd
Buffalo, NY 14202
Phone (716) 849-8750

50 Lakefront Blvd
Ste 130
Buffalo, NY 14202
Phone (716) 849-8750

151 Bennett Rd
Cheektowaga, NY 14227
Phone (716) 961-9663

4975 Strickler Rd
Clarence, NY 14031

2700 N Forest Rd
Getzville, NY 14068
Phone (716) 639-3311

4650 Southwestern Blvd
Hamburg, NY 14075
Phone (716) 648-2450

3333 Elmwood Ave
Kenmore, NY 14217
Phone (716) 874-1566

Interoperability endpoints

  • Direct secure messaging: cmontgomery@mobileprimarycare.medentdirect.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/HEGDAA

Organizations & group practices 5

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": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650931200000",
    "number": "1720053416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 LA RIVIERE DR STE 201",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142024344",
            "telephone_number": "716-893-1010",
            "fax_number": "716-893-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 LA RIVIERE DR STE 201",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142024344",
            "telephone_number": "716-893-1010",
            "fax_number": "716-893-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "CAROLYN",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NY",
            "license": "F340627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.