NPIMap

Organization Active NPI

Age Well Concierge Medicine

  • Family Medicine Physician
  • Montgomery, TX
National Provider Identifier
1952919490
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AGE WELL CONCIERGE MEDICINE
Practice address
18441 TX-105
Suite B
Montgomery, TX 77356
Phone
(936) 494-9520
NPI assigned
Jul 21, 2020
Last updated
Jul 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

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

Authorized official

Name
Monica Milford, FNPNPI 1467919530
Title
Coo
Phone
(936) 494-9520

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

18441 TX-105
Suite B
Montgomery, TX 77356

Mailing address

224 Lake Estates Dr
Montgomery, TX 77356-4806
Phone (936) 494-9520

Other identifiers 3

IdentifierTypeStateIssuer
1922335199OtherTXBCBS
1922335199OtherTXAETNA
1922335199OtherTXCIGNA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1595289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1952919490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 LAKE ESTATES DR",
            "city": "MONTGOMERY",
            "state": "TX",
            "postal_code": "773564806",
            "telephone_number": "936-494-9520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18441 TX-105",
            "address_2": "SUITE B",
            "city": "MONTGOMERY",
            "state": "TX",
            "postal_code": "77356",
            "telephone_number": "936-494-9520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGE WELL CONCIERGE MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-21",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "MILFORD",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "936-494-9520",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1922335199",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1922335199",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1922335199",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.