NPIMap

Individual provider Active NPI

Emily Kathryn Montgomery-Deem, P.A.-C

  • Physician Assistant
  • Charleston, WV
National Provider Identifier
1720075369
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
01215 Issued in WV
Practice address
1220 Lee St E Ste 100
Charleston, WV 25301-1864
Phone
(304) 388-1965
NPI assigned
Sep 29, 2005
Last updated
Sep 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 01215 WV Primary

Addresses

Primary practice location

1220 Lee St E Ste 100
Charleston, WV 25301-1864

Mailing address

2619 Larwood Dr
Charleston, WV 25302-4319
Phone (304) 741-5984

Other names 1

  • Mrs. Emily Kathryn Montgomery-Deem Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20070808000004 WV Practitioner - Physician Assistant 9133156680 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1220 Lee St E
Charleston, WV 25301-1864

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-5432

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1215WVMDClinical Psychologist
01215WVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center, Inc. CurrentSince Oct 28, 2024 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Oct 28, 2024 Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients

Locations

1220 Lee St E
Ste 100
Charleston, WV 25301
Phone (304) 388-1965

3200 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 388-2550

400 Association Dr
Ste 102
Charleston, WV 25311
Phone (304) 388-1762

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

800 Pennsylvania Ave
Charleston, WV 25302
Phone (304) 388-2550

1400 Hospital Dr
Hurricane, WV 25526
Phone (304) 757-1700

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 11

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": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1720075369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2619 LARWOOD DR",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253024319",
            "telephone_number": "304-741-5984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 LEE ST E STE 100",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011864",
            "telephone_number": "304-388-1965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY-DEEM",
        "first_name": "EMILY",
        "middle_name": "KATHRYN",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-29",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "01215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "MONTGOMERY-DEEM",
            "middle_name": "KATHRYN",
            "prefix": "MRS.",
            "credential": "P.A.-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.