Mr Keith Allen Montgomery Jr, NP is a medicare enrolled "Nurse Practitioner" in Adelanto, California. His current practice location is
11965 Cactus Rd, Adelanto, California. You can reach out to his office (for appointments etc.) via phone at
(760) 561-6081.
Mr Keith Allen Montgomery Jr is licensed to practice in California (license number 95008198) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1790978617.
Provider's Profile
| Full Name | Mr Keith Allen Montgomery Jr |
|---|
| Gender | Male |
|---|
| Speciality | Nurse Practitioner |
|---|
| Location | 11965 Cactus Rd, Adelanto, California |
|---|
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
|---|
NPI Data:
- NPI Number: 1790978617
- Provider Enumeration Date: 08/23/2007
- Last Update Date: 07/12/2018
Medicare PECOS Information:
- PECOS PAC ID: 9830445725
- Enrollment ID: I20180706002298
Medical Identifiers
Medical identifiers for Mr Keith Allen Montgomery Jr such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1790978617 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 163WM0705X | Registered Nurse - Medical-surgical | 758758 (California) | Secondary |
| 363L00000X | Nurse Practitioner | 95008198 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Keith Allen Montgomery Jr allows following entities to bill medicare on his behalf.
| Entity Name | Unicare Community Health Center, Inc. |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1265854061
PECOS PAC ID: 8426369067
Enrollment ID: O20150623001589 |
|---|
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Keith Allen Montgomery Jr is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Keith Allen Montgomery Jr, NP
625 Fair Oaks Ave Ste 270,
South Pasadena, CA 91030-5801
Ph: (626) 346-2455 | Mr Keith Allen Montgomery Jr, NP
11965 Cactus Rd,
Adelanto, CA 92301-4906
Ph: (760) 561-6081 |
Reviews and Comments