MONTGOMERY MEDCORP, INC.
NPI 1619061702
Pediatrics in Montgomery, WV

NPI Status: Active since October 03, 2006

Contact Information

401 6TH AVE
MONTGOMERY, WV
ZIP 25136
Phone: (304) 442-5151

NPI Profile Information
Primary Taxonomy
Group Taxonomy
Insurance Plans Accepted
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Pediatrics
Accepts Insurance
CLIA Number: 51D2291872
CLIA Cert. Type: Physician Office
CLIA Exp. Date: 10-16-2025

About MONTGOMERY MEDCORP, INC.

This page provides the complete NPI Profile along with additional information for Montgomery Medcorp, Inc., a pediatrician established in Montgomery, West Virginia operating as a Pediatrics. The healthcare provider is registered in the NPI registry with number 1619061702 assigned on October 2006. The practitioner's primary taxonomy code is 208000000X. The provider is registered as an organization and their NPI record was last updated 5 years ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Angela Sizemore (Business Office Director)

NPI: 1619061702
Provider Name: MONTGOMERY MEDCORP, INC.
Entity Type: Organization
Location Address: 401 6TH AVE MONTGOMERY, WV 25136
Location Phone: (304) 442-5151
Mailing Address: 401 6TH AVE MONTGOMERY, WV 25136
Mailing Phone: (304) 442-5151
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 10-03-2006
Last Update Date: 08-22-2020
Code Navigator

A pediatrician like Montgomery Medcorp, Inc. is a physician who has completed a pediatric residency and is board-certified or board-eligible in a pediatric specialty. Pediatric care providers are trained to care for newborns, infants, children and adolescents. A pediatrician could perform physical exams, manage vaccinations, monitor development milestones, diagnose illnesses, infections, injuries or other health problems, etc.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Pediatrics
Taxonomy Code: 208000000X
Type: Allopathic & Osteopathic Physicians
Taxonomy Description: A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Group Taxonomy 193400000X MULTIPLE SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

CareSource

Bronze First 7500 $25 Generic Drugs - HMO
Bronze First 7500 $25 Generic Drugs Adult Vision & Fitness - HMO
Diabetes Gold 1100 $0 Select Drugs & Specialized Services - HMO
Diabetes Gold 1100 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
Diabetes Silver 4000 $0 Select Drugs & Specialized Services - HMO
Diabetes Silver 4000 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
Gold 1500 $15 Generic Drugs - HMO
Gold 1500 $15 Generic Drugs Adult Vision & Fitness - HMO
Healthy Heart Gold 1500 $0 Select Drugs & Specialized Services - HMO
Healthy Heart Gold 1500 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
Healthy Heart Silver 4500 $0 Select Drugs & Specialized Services - HMO
Healthy Heart Silver 4500 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
Low Deductible Silver 4500 $3 Generic Drugs - HMO
Low Deductible Silver 4500 $3 Generic Drugs Adult Vision & Fitness - HMO
Low Premium Silver 6000 $3 Generic Drugs - HMO
Low Premium Silver 6000 $3 Generic Drugs Adult Vision & Fitness - HMO
Platinum Zero $5 Generic Drugs - HMO
Platinum Zero $5 Generic Drugs Adult Vision & Fitness - HMO
Silver 5000 $20 Generic Drugs - HMO
Silver 5000 $20 Generic Drugs Adult Vision & Fitness - HMO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: ANGELA SIZEMORE
Authorized Official Title: BUSINESS OFFICE DIRECTOR
Authorized Official Phone: (304) 442-1251

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
4000066000	MEDICAID (05)	WV

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number: 51D2291872
Facility Type: Physician Office
Certificate Effective Date: October 17, 2023
Certificate Expiration Date: October 16, 2025
Laboratory Director: DR. SAMMAR ATASSI
Certificate Type: Certificate of Waiver
Certificate Type Description: This CLIA certificate is issued to Montgomery Medcorp, Inc. to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	6	1	9	0	6	1	7	0	2
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	6	2	9	0	6	2	7	0
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 6 + 2 + 9 + 0 + 6 + 2 + 7 + 0 + 24 = 58
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 58 = 2									2

The NPI number 1619061702 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location

The following 20 providers are registered at the same or nearby location.

DR. GHASSAN Y DAGHER MD

Ophthalmology

401 6TH AVE
SUITE 110
MONTGOMERY, WV
ZIP 25136

About MONTGOMERY MEDCORP, INC.

Location Map

Specialty - Primary Taxonomy

Pediatrics

Group Taxonomy 193400000X MULTIPLE SINGLE SPECIALTY GROUP

Insurance Plans Accepted

CareSource

Medicare

Medicaid

Authorized Official

ANGELA SIZEMORE

Additional Identifiers

CLIA Information

Reviews for MONTGOMERY MEDCORP, INC.

NPI Validation Check Digit Calculation

Other Providers at the Same Location

Frequently Asked Questions

What is MONTGOMERY MEDCORP, INC.'s NPI number?

Where is the provider located?

What is the provider's specialty?

What insurance does MONTGOMERY MEDCORP, INC. accept?