NPIMap

Individual provider Active NPI

Jeffrey Michael Montgomery, D.O.

  • Family Medicine Physician
  • Clarks Summit, PA
National Provider Identifier
1902007990
Registry record updated Aug 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS014541 Issued in PA
Practice address
407 N State St
Clarks Summit, PA 18411-1061
Phone
(570) 586-1134
Fax
(570) 586-1136
NPI assigned
May 29, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2021

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 OS014541 PA Primary

Addresses

Primary practice location

407 N State St
Clarks Summit, PA 18411-1061

Mailing address

407 N State St
Clarks Summit, PA 18411-1061
Phone (570) 586-1134

Other identifiers 1

IdentifierTypeStateIssuer
102210583MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jeffrey.montgomery.1@21771.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20081007000060 PA Practitioner - Family Practice 4082782859 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

407 N State St
Physicians Health Alliance
Clarks Summit, PA 18411-1061
Phone (570) 586-1134

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.17 of 100Reported as apm
Quality
78.34
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Scranton Quincy Clinic Company LLC Family Medicine CurrentSince Jan 1, 2012 Accepting new patients
Physicians Health Alliance Inc Past Accepting new patients

Locations

150 Brooklyn St
Carbondale, PA 18407
Phone (570) 282-2031

407 N State St
Clarks Summit, PA 18411
Phone (570) 586-1134

315 S Main St
Old Forge, PA 18518
Phone (570) 457-8364

1401 Electric St
Scranton, PA 18509
Phone (570) 770-5929

Interoperability endpoints

  • Direct secure messaging: jeffrey.montgomery.1@21771.direct.athenahealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 63

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

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627776000000",
    "number": "1902007990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 N STATE ST",
            "city": "CLARKS SUMMIT",
            "state": "PA",
            "postal_code": "184111061",
            "telephone_number": "570-586-1134",
            "fax_number": "570-586-1136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 N STATE ST",
            "city": "CLARKS SUMMIT",
            "state": "PA",
            "postal_code": "184111061",
            "telephone_number": "570-586-1134",
            "fax_number": "570-586-1136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "JEFFREY",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-29",
        "last_updated": "2021-08-01",
        "certification_date": "2021-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS014541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102210583",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeffrey.montgomery.1@21771.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "407 N State St",
            "city": "Clarks Summit",
            "state": "PA",
            "country_code": "US",
            "postal_code": "184111061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clarks Summit, PA

Sources for this page

Verify at the official NPI Registry.