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MR. KEITH ALLEN MONTGOMERY JR. N.P.
NPI 1790978617
Nurse Practitioner in Adelanto, CA

Active since August 23, 2007PECOS Enrolled
11965 CACTUS RD, ADELANTO, CA 92301(760) 561-6081(877) 778-9461 Get Directions Write a Review

NPPES record last updated: July 12, 2018. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mr. Keith Allen Montgomery Jr. N.p. NPPES

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

MR. KEITH ALLEN MONTGOMERY JR. N.P. (NPI 1790978617) is an individual nurse practitioner in Adelanto, California, licensed in California (95008198) and active in the NPI registry since August 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1790978617
Entity TypeIndividualMale
Primary Taxonomy363L00000X
Provider Legal NameMR. KEITH ALLEN MONTGOMERY JR.Credential: N.P.
Location Address11965 CACTUS RDAdelanto, CA 92301-4906
Mailing Address625 Fair Oaks Ave Ste 270South Pasadena, CA 91030-5801 · (626) 346-2455 · Fax (626) 639-3005
Phone(760) 561-6081
Fax(877) 778-9461
Sole ProprietorNo
Enumeration DateAugust 23, 2007
Last NPPES UpdateJuly 12, 2018
✔ NPI 1790978617 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in CA · 95008198
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Also ListedRegistered Nurse · Medical-SurgicalTaxonomy 163WM0705X · License 758758 (CA)
11965 CACTUS RD, Adelanto, CA 92301
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Keith Allen Montgomery Jr. N.p. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Reassignment

Medicare enrollment records show Keith Montgomery reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Unicare Community Health Center, Inc.
7.7 mi
Federally Qualified Health Center (FQHC)
15863 KASOTA RD
Apple Valley, CA 92307
  • Reassigned Medicare billing, California enrollment
  • 119 clinicians in this Medicare group
NPI 1699465732 (760) 946-1100

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 92301 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
$91.88 typical visit price
range $59.60 – $179.42
Typical copayment $22.97 (range $14.90 – $44.85)
Most-billed visit code 99203
Established Patient
$104.64 typical visit price
range $19.37 – $146.42
Typical copayment $26.16 (range $4.84 – $36.60)
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.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MOLINA HEALTHCARE OF CALIFORNA
Family Medicine
11965 CACTUS RD
ADELANTO, CA 92301
San Bernardino County (760) 561-6081
JOSEPH M MOLINA MD PROFESSIONAL CORPORATION-SOUTHERN CALIFORNIA
Family Medicine
11965 CACTUS RD
ADELANTO, CA 92301
San Bernardino County (760) 561-6081
JOSEPH M MOLINA MD PROFESSIONAL CORPORATION SOUTHERN CALIFORNIA
Non-Pharmacy Dispensing Site
11965 CACTUS RD
ADELANTO, CA 92301
San Bernardino County (760) 561-6081

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 Keith Montgomery's NPI number?

The NPI number for Keith Montgomery is 1790978617. It was assigned to this individual provider in the NPPES registry on August 23, 2007.

Where is Keith Montgomery located?

Keith Montgomery practices at 11965 Cactus Rd, Adelanto, CA 92301. The listed phone number is (760) 561-6081.

What is Keith Montgomery's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Keith Montgomery enrolled in Medicare?

Yes. Keith Montgomery is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Keith Montgomery's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Keith Montgomery reassigns Medicare benefits to Unicare Community Health Center, Inc. (Apple Valley, CA). The 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 Keith Montgomery's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Keith Montgomery was last updated on July 12, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years 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.