Gretchen Suzanne Montgomery, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

18545 Issued in MS

Practice address

969 Lakeland Dr
Jackson, MS 39216-4606

Phone

(601) 200-6175

Fax

(601) 200-2020

NPI assigned

Jun 20, 2006

Last updated

Jul 26, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Gretchen Willock Professional name

Medicare fee-for-service enrollment

Enrolled in MS, CA, TX3 enrollments

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 3

Specialty

Emergency Medicine

Education

University of Iowa, RJ & L Carver College of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrative Emergency Services Physician Group-Houston PLLCGroup PAC ID 7113258500, 212 clinicians

Jackson HB Medical Services LLCGroup PAC ID 6103273131, 50 clinicians

Relias Emergency Medicine Specialists of St Dominic LLCGroup PAC ID 2466840152, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Dominic-Jackson Memorial Hospital Hospital, Jackson, MS, CCN 250048
• Merit Health River Oaks Hospital, Flowood, MS, CCN 250138

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Jackson HB Medical Services LLC

  dba Merit Health Central

  • Emergency Medicine Physician
  • Jackson, MS
  • NPI 1184305856
  Medicare reassignment Care Compare group NPD
• Relias Emergency Medicine Specialists of St Dominic LLC

  • Emergency Medicine Physician
  • Jackson, MS
  • NPI 1235808122
  Medicare reassignment Care Compare group NPD
• Integrative Emergency Services Physician Group-Houston PLLC

  dba IES Houston

  • Emergency Medicine Physician
  • Pasadena, TX
  • NPI 1801458708
  Medicare reassignment Care Compare group NPD
• Team Physicians of Northern California Medical Group Inc

  • Emergency Medicine Physician
  • Pleasanton, CA
  • NPI 1649692716
  Medicare reassignment
• Emcare Physician Providers, Inc.

  • Emergency Medicine Physician
  • Natchez, MS
  • NPI 1700835550
  NPD (past)
• Miss-Lou Emergency Physicians

  • Emergency Medicine Physician
  • Natchez, MS
  • NPI 1740239656
  NPD (past)
• St. Luke's Community Health Services

  • Rehabilitation Hospital Unit
  • The Woodlands, TX
  • NPI 1255785382
  NPD (past)

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

• River Oaks Hospital LLC

  dba Merit Health River Oaks

  • General Acute Care Hospital
  • Flowood, MS
  • NPI 1396792032
  Care Compare affiliation
• St Dominic-Jackson Memorial Hospital

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1306876065
  Care Compare affiliation

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690329600000",
    "number": "1932145067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 TWIN CEDARS DR",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391107288",
            "telephone_number": "601-278-3269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164606",
            "telephone_number": "601-200-6175",
            "fax_number": "601-200-2020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6001 Norris Canyon Rd",
            "address_purpose": "LOCATION",
            "city": "San Ramon",
            "state": "CA",
            "postal_code": "945835400",
            "country_code": "US",
            "telephone_number": "925-275-9200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "GRETCHEN",
        "middle_name": "SUZANNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-20",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "C175540",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "18545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05957798",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRETCHEN",
            "last_name": "WILLOCK",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Lara Monico, M.C.D.
• Linda P Monroe, M.D.
• Sureena Monteiro-Pai, MD
• Bentley Montgomery
• Carver Odom Montgomery, MD
• Jessica Ann Montgomery, AGACNP-BC
• Kia Danielle Montgomery, NP
• Patricia Elaine Montgomery, ADDICTION THERAPIST
• Yolonda Montgomery
• Alexis Lomax Montpelier

• Emergency Medicine Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Emergency Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2023; 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.