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MRS. EBONY MONIQUE MONTGOMERY APRN
NPI 1629531595
Nurse Practitioner - Gerontology in Jacksonville, AR

Active since April 08, 2019PECOS EnrolledAccepts Medicare Assignment
1410 BRADEN STREET, JACKSONVILLE, AR 72076(870) 280-2578(844) 447-2520 Get Directions Write a Review

NPPES record last updated: February 26, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Feb 26, 2025, Nov 4, 2024, Feb 8, 2021 and 2 more (5 updates tracked since 2019).

About Mrs. Ebony Monique Montgomery Aprn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. EBONY MONIQUE MONTGOMERY APRN (NPI 1629531595) is an individual gerontology provider in Jacksonville, Arkansas, licensed in Arkansas (125407) and active in the NPI registry since April 2019. She is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1629531595
Entity TypeIndividualFemale
Primary Taxonomy363LG0600X
Provider Legal NameMRS. EBONY MONIQUE MONTGOMERYCredential: APRN
Location Address1410 BRADEN STREETJacksonville, AR 72076
Mailing Address500 Sw 7th St Stea205Renton, WA 98057 · (877) 522-1275 · Fax (833) 888-7145
Phone(870) 280-2578
Fax(844) 447-2520
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateApril 8, 2019
Last NPPES UpdateFebruary 26, 20255 updates tracked since enumeration
NPPES CertifiedFebruary 26, 2025
✔ NPI 1629531595 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · GerontologyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LG0600X
License✔ Licensed in AR · 125407
1410 BRADEN STREET, Jacksonville, AR 72076
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Ebony Monique Montgomery Aprn is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2769894583
PECOS Enrollment IDI20201218001118, I20250409002573
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

3

Medicare enrollment records show Ebony Montgomery reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Wound Care Plus, LLC
280 mi
Specialist
100 S 4TH ST STE 550
Saint Louis, MO 63102
  • Reassigned Medicare billing, Arkansas enrollment
  • 6 clinicians in this Medicare group
NPI 1841657053 (888) 402-0202
Ideal Option, PLLC
1,616 mi
Clinic/Center
8508 W GAGE BLVD STE A101
Kennewick, WA 99336
  • Reassigned Medicare billing, Arkansas and Washington enrollments
  • 32 clinicians in this Medicare group
NPI 1457788275 (877) 522-1275
Ideal Telemedicine Services, LLC
1,778 mi
Clinic/Center
500 SW 7TH ST STE A205
Renton, WA 98057
  • Reassigned Medicare billing, Arkansas and Washington enrollments
  • 32 clinicians in this Medicare group
NPI 1346754868 (877) 522-1275

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 72076 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$79.72 typical visit price
range $51.36 – $157.74
Typical copayment $19.93 (range $12.84 – $39.43)
Most-billed visit code 99203
Established Patient
$91.63 typical visit price
range $16.16 – $128.77
Typical copayment $22.90 (range $4.04 – $32.19)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ebony Montgomery's NPI number?

The NPI number for Ebony Montgomery is 1629531595. It was assigned to this individual provider in the NPPES registry on April 8, 2019.

Where is Ebony Montgomery located?

Ebony Montgomery practices at 1410 Braden Street, Jacksonville, AR 72076. The listed phone number is (870) 280-2578.

What is Ebony Montgomery's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

Is Ebony Montgomery enrolled in Medicare?

Yes. Ebony Montgomery is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Ebony Montgomery's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ebony Montgomery reassigns Medicare benefits to 3 organizations: Wound Care Plus, LLC (Saint Louis, MO), Ideal Option, PLLC (Kennewick, WA) and Ideal Telemedicine Services, LLC (Renton, WA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Ebony Montgomery's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Ebony Montgomery accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 9 other insurers list Ebony Montgomery as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ebony Montgomery was last updated on February 26, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.