Keith Allen Montgomery Jr., N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95008198 Issued in CA

Practice address

11965 Cactus Rd
Adelanto, CA 92301-4906

Phone

(760) 561-6081

Fax

(877) 778-9461

NPI assigned

Aug 23, 2007

Last updated

Jul 12, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Unicare Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Riverside, CA
  • NPI 1639066491
  Medicare reassignment NPD
• Unicare Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • San Bernardino, CA
  • NPI 1205393238
  NPD

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

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531353600000",
    "number": "1790978617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 FAIR OAKS AVE STE 270",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910305801",
            "telephone_number": "626-346-2455",
            "fax_number": "626-639-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11965 CACTUS RD",
            "city": "ADELANTO",
            "state": "CA",
            "postal_code": "923014906",
            "telephone_number": "760-561-6081",
            "fax_number": "877-778-9461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "KEITH",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-23",
        "last_updated": "2018-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95008198",
            "primary": true
        },
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "CA",
            "license": "758758",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandros George Marneris, OD
• Mercy Meadows (Mercy Meadows Developmental Home)
• Ramez Michail
• Molina Healthcare of Californa
• Paul Johnson Bas Molina, PHARM.D.
• Breanna Moore
• Brittany Marie Morrison, MA, AMFT
• Amanda Murray
• Joseph Dominick Muto, PSY.D.
• New Leaf Ministries

• Nurse Practitioner in Adelanto, CA
• Providers in Adelanto, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.