Kevin Maxwell Montgomery, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

92030 Issued in GA

Practice address

809 82ND Pkwy
Myrtle Beach, SC 29572-4607

Phone

(843) 692-1752

NPI assigned

Mar 21, 2019

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 GA

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

Specialty

Emergency Medicine

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Inphynet Primary Care Physicians Southeast PCGroup PAC ID 3779497045, 71 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Francis Hospital- Emory Healthcare Hospital, Columbus, GA, CCN 110129

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• Inphynet Primary Care Physicians Southeast PC

  • Emergency Medicine Physician
  • Columbus, GA
  • NPI 1770521460
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Francis Health LLC

  dba St Francis Hospital

  • General Acute Care Hospital
  • Columbus, GA
  • NPI 1033228168
  Care Compare affiliation

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

{
    "created_epoch": "1553126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1881154375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 82ND PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724607",
            "telephone_number": "843-692-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 82ND PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724607",
            "telephone_number": "843-692-1752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "KEVIN",
        "middle_name": "MAXWELL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-21",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "92030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paula Montana
• Zamarit Montes, CRNA
• Brandi Leigh Montgomery, PHARMD
• Caitlin Montgomery, CCC-SLP
• James Calvin Montgomery, MD
• Monticello Hospice LLC (Monticello Hospice)
• Abby Nicole Moore, M.A., CF-SLP
• Bailey Moore, RBT
• Christopher John Moore
• Janice Moore, FNP

• Emergency Medicine Physician in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Emergency Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.