Autumn Montville, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

66038 Issued in MN

Practice address

345 Smith Ave N
Saint Paul, MN 55102-2346

Phone

(612) 813-6000

NPI assigned

Apr 16, 2018

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 names 1

• Autumn Tani-Winegarden Former name

Medicare fee-for-service enrollment

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amontville355974@ehrdirect.mayoclinicmsg.org

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.

• Childrens Health Care

  • Pediatrics Physician
  • Minneapolis, MN
  • NPI 1932208808
  Medicare reassignment NPD
• Children'S Health Care

  • Certified Registered Nurse Anesthetist
  • Minneapolis, MN
  • NPI 1942488382
  NPD
• Childrens Health Care

  • Children's Hospital
  • Minneapolis, MN
  • NPI 1881793750
  NPD

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1962999862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 SMITH AVE N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022346",
            "telephone_number": "612-813-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 SMITH AVE N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022346",
            "telephone_number": "612-813-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTVILLE",
        "first_name": "AUTUMN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-16",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "29302",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "66038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUTUMN",
            "last_name": "TANI-WINEGARDEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michelle Montelibano, M.S., CCC
• Joseph Alexander Montgomery
• Piyanud A Montgomery
• Gerald L Montie, MD
• Walter Montpetit
• April Moo
• Gay Say Moo
• Htee Wah Moo
• Lay Moo
• Barbara Gayle Moody, OTR

• Pediatrics Physician in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.