Jeremiah R Montgomery, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

103911 Issued in NC

Practice address

2604 Medical Office PL
Goldsboro, NC 27534-9417

Phone

(919) 580-0004

Fax

(919) 580-9099

NPI assigned

Oct 18, 2005

Last updated

Jun 5, 2024By 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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Physician Assistant

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Immediate Care of Goldsboro PLLCGroup PAC ID 5991603979, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Immediate Care of Goldsboro, PLLC

  • Emergency Care Clinic/Center
  • Goldsboro, NC
  • NPI 1952397028
  Medicare reassignment Care Compare group
• Goldsboro Emergency Medical Specialists, Inc.

  • Emergency Medicine Physician
  • Goldsboro, NC
  • NPI 1164418232
  Medicare reassignment

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1952390353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2604 MEDICAL OFFICE PL",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275349417",
            "telephone_number": "919-580-0004",
            "fax_number": "919-580-9099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2604 MEDICAL OFFICE PL",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275349417",
            "telephone_number": "919-580-0004",
            "fax_number": "919-580-9099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "JEREMIAH",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103911",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "103911",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "103911",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "Q01227",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Earl Mitchell, OD
• Megan Moeller, L.P.C.
• Aminu Isyaku Mohammed, M.D.
• Monarch
• Belinda Jacobs Montanez, BA, ITFS
• Marisa M Montgomery, NP
• Janice M Moon, RPH
• Christopher Mooney, PA-C
• Moonlight Nursing, PLLC (Moonlight Nursing Care)
• Brian Edward Moore Jr., M.D.

• Physician Assistant in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; 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.