JAZZMYNE T MONTGOMERY (NPI# 1811516065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811516065 |
| Entity Type | Individual |
| Full Name | JAZZMYNE T MONTGOMERY |
| Credential | MD |
| Practice Address |
747 N Rutledge St Springfield IL 62702-6700 |
| Mailing Address |
Po Box 19665 Springfield IL 62794-9665 |
| Practice Telephone | 2175453262 |
| Practice Fax Number | 2175457305 |
| Mailing Telephone | 2175453262 |
| Mailing Fax Number | 2175457305 |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2020-04-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 125075468 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
747 N RUTLEDGE ST |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-6700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619974532 | Neha N Amin | Obstetrics & Gynecology | 747 N Rutledge St, Baylis Building, 2nd Floor, Springfield, IL 62702-6700 | 2005-07-07 |
| 1295343648 | Katherine G Brockhouse | Nurse Practitioner | 747 N Rutledge St, Springfield, IL 62702-6700 | 2020-07-21 |
| 1376151258 | Lauren Woldanski | Plastic Surgery | 747 N Rutledge St, Springfield, IL 62702-6700 | 2020-07-16 |
| 1356968358 | Jessie Laina Koljonen | Plastic Surgery | 747 N Rutledge St, Springfield, IL 62702-6700 | 2020-06-25 |
| 1487274882 | Tiffany Lynn Damm | Urology | 747 N Rutledge St, Springfield, IL 62702-6700 | 2020-04-26 |
| 1639738644 | Alexis Ruffolo | Plastic Surgery | 747 N Rutledge St, Springfield, IL 62702-6700 | 2019-06-12 |
| 1922667930 | Justin D Sawyer | Plastic Surgery | 747 N Rutledge St, Springfield, IL 62702-6700 | 2019-06-12 |
| 1174016950 | Michael Romanelli | Plastic Surgery | 747 N Rutledge St, Springfield, IL 62702-6700 | 2018-06-07 |
| 1902398357 | William James Bruce | Plastic Surgery | 747 N Rutledge St, Springfield, IL 62702-6700 | 2018-06-01 |
| 1619497773 | Danielle Olla | Plastic Surgery | 747 N Rutledge St, Springfield, IL 62702-6700 | 2017-06-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| Find all providers in zip 62702 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649796376 | Urology Associates PC | Urology | 502 Northcrest Dr, Springfield, TN 37172-4066 | 2017-08-15 |
| 1912436015 | Robert Ara Petrossian | Urology | 301 N 8th St # 4b143c, Springfield, IL 62701-1041 | 2017-06-12 |
| 1932463940 | Brandi Dawn Miller | Urology | 1965 S Fremont Ave Ste 370, Springfield, MO 65804-2284 | 2012-06-25 |
| 1699049395 | Harry L. Ellis | Urology | 5034 S Glenhaven Ave, Springfield, MO 65804-7804 | 2012-02-28 |
| 1427121714 | David R Kelley | Urology | 100 Wason Anenue, Suite 120, Springfield, MA 01107-1119 | 2006-11-16 |
| 1942373311 | Charles D Parsons | Urology | 202 S Belmont Ave, Springfield, OH 45505-1224 | 2006-11-15 |
| 1447321781 | Pbm Urology Ltd | Urology | 1215 S 4th St, Springfield, IL 62703-2259 | 2006-11-10 |
| 1013019439 | Alexander M Berry | Urology | 100 Wason Ave, Suite 240, Holyoke Medicacal Center - Urology, Springfield, MA 01107 | 2006-09-05 |
| 1972615748 | Thomas E. Baron | Urology | 800 N. 1st Street, Springfield, IL 62702 | 2006-08-31 |
| 1265405914 | Eric Espinosa | Urology | 1164 E Home Rd, Suite J, Springfield, OH 45503-2726 | 2006-02-10 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62702 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.