Individual provider Active NPI

Rebecca Piles Montgomery, MD

  • Family Medicine Physician
  • Davidson, NC
National Provider Identifier
1760478358
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9600646 Issued in NC
Practice address
104 Knox CT Ste 100
Davidson, NC 28036-0590
Phone
(704) 892-5454
Fax
(704) 892-5858
NPI assigned
Sep 20, 2005
Last updated
Dec 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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 9600646 NC Primary

Addresses

Primary practice location

104 Knox CT Ste 100
Davidson, NC 28036-0590

Mailing address

PO Box 4329
Davidson, NC 28036-4329
Phone (704) 892-5454

Other practice location 1

150 Fairview Rd Ste 210
Mooresville, NC 28117-9507
Phone (704) 235-0300

Other identifiers 1

IdentifierTypeStateIssuer
891010LMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20050224000602 NC Practitioner - Family Practice 8527011030 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kentucky College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avance Care PAGroup PAC ID 3577634476, 244 clinicians

Practice addresses (Care Compare)

104 Knox CT
Suite 100
Davidson, NC 28036-0590
Phone (704) 892-5454

7510 Ramble Way
Suite 107
Raleigh, NC 27616-4305
Phone (919) 747-3033

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9600646NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Avance Care, PA CurrentSince Oct 1, 2023 Accepting new patients
Afc Urgent Care and Family Care of WNC, PLLC CurrentSince Oct 7, 2020 Accepting new patients
Advanced Healthcare Family Medicine Past Accepting new patients

Locations

10102 Johnston Rd
Charlotte, NC 28210
Phone (704) 247-6578

14001 E Independence Blvd
Ste C
Indian Trail, NC 28079
Phone (704) 247-6598

7510 Ramble Way
Ste 107
Raleigh, NC 27616
Phone (919) 277-8880

1025 Peerless Xing NW
Cleveland, TN 37312
Phone 4234765990 ext. 104

Interoperability endpoints

  • Direct secure messaging: rebecca.montgomery.1@29681.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1760478358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4329",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280364329",
            "telephone_number": "704-892-5454",
            "fax_number": "704-892-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 KNOX CT STE 100",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280360590",
            "telephone_number": "704-892-5454",
            "fax_number": "704-892-5858"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 Fairview Rd Ste 210",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281179507",
            "country_code": "US",
            "telephone_number": "704-235-0300",
            "fax_number": "704-235-1803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "REBECCA",
        "middle_name": "PILES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-20",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9600646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891010L",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davidson, NC

Sources for this page

Verify at the official NPI Registry.