NPIMap

Organization Active NPI

Montgomery Medical, Inc.

  • Clinic/Center
  • Smithfield, PA
National Provider Identifier
1821336868
Registry record updated Dec 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
072269 L Issued in PA
Legal business name
MONTGOMERY MEDICAL, INC.
Practice address
105 Laurel View Dr
Smithfield, PA 15478-8908
Phone
(724) 569-8100
NPI assigned
Jan 25, 2013
Last updated
Dec 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2023

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

Authorized official

Name
Marcy Goisse, M.D.NPI 1508875774
Title
President
Phone
(724) 569-8100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 072269 L PA Primary

Addresses

Primary practice location

105 Laurel View Dr
Smithfield, PA 15478-8908

Mailing address

100 Ridgeview Dr Unit 3
Smithfield, PA 15478-1650
Phone (724) 569-8100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130507000417 PA Part B Supplier - Clinic/Group Practice 1355588542 Receives reassigned benefits from 12 practitioners
Practice locations: Smithfield, PA

National Provider Directory

National Provider Directory

Locations

105 Laurel View Dr
Smithfield, PA 15478
Phone (724) 569-8100

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1359072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702857600000",
    "number": "1821336868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 RIDGEVIEW DR UNIT 3",
            "city": "SMITHFIELD",
            "state": "PA",
            "postal_code": "154781650",
            "telephone_number": "724-569-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 LAUREL VIEW DR",
            "city": "SMITHFIELD",
            "state": "PA",
            "postal_code": "154788908",
            "telephone_number": "724-569-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-25",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A",
        "authorized_official_last_name": "GOISSE",
        "authorized_official_first_name": "MARCY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "724-569-8100",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "PA",
            "license": "072269 L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithfield, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.