MR. TRAVIS MONTGOMERY (NPI# 1679054696) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1679054696 |
Entity Type | Individual |
Full Name | MR. TRAVIS MONTGOMERY |
Credential | RNFA |
Practice Address |
4400 W 95th St Ste 308 Oak Lawn IL 60453-2660 |
Mailing Address |
9500 Bormet Dr Ste 204 Mokena IL 60448-8399 |
Practice Telephone | 7083464040 |
Practice Fax Number | 7083463287 |
Mailing Telephone | 7083464044 |
Mailing Fax Number | 7083463287 |
Enumeration Date | 2018-08-27 |
Last Update Date | 2020-04-08 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 246ZC0007X |
Specialist/Technologist, Other Specialization: Surgical Assistant |
238000654 | IL | Technologists, Technicians & Other Technical Service Providers |
N | 163WR0006X |
Registered Nurse Specialization: Registered Nurse First Assistant |
041472495 | IL | Nursing Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IL | IL RN LICENSE | 041472495 | 01 |
IL | IL SA LICENSE | 238000654 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1154323731 | Travis J Montgomery | Podiatrist | 3731 Guion Road, Suite C, Indianapolis, IN 46222-7604 | 2005-08-12 |
1316210040 | Travis H Montgomery | Physician Assistant | 222 Medical Cir, Morehead, KY 40351-1179 | 2012-02-10 |
Street Address |
4400 W 95TH ST STE 308 |
City | OAK LAWN |
State | IL |
Zip Code | 60453-2660 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1437159142 | Philip Joseph Alexander | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2005-07-22 |
1457912834 | Shannon Lyn Mcnamara | Physician Assistant | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2019-06-26 |
1043777832 | Catherine Gaissert | Physician Assistant | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2019-02-27 |
1558826735 | Jeffrey Peyton Webb | Nurse Practitioner | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2019-02-01 |
1407327638 | Dakota Walther | Physician Assistant | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2018-12-16 |
1538644273 | Katarzyna M Krzycka | Physician Assistant | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2018-09-28 |
1518463330 | Nicole Annes | Physician Assistant | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2018-04-02 |
1548769466 | Laura Bergquist | Specialist/Technologist, Other | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2018-02-06 |
1891208617 | Jenifer K Wong-yu | Physician Assistant | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2017-11-15 |
1285153536 | Courtney Mcneill | Physician Assistant | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2017-09-18 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1659995231 | Natalia Zero | Student in an Organized Health Care Education/Training Program | 4440 W 95th St, Rm 131 North, Oak Lawn, IL 60453 | 2020-05-30 |
1114554300 | Sylvia Maria Chlebek | Student in an Organized Health Care Education/Training Program | Advocate Christ Medical Center 4440 W. 95th St., Rm 131 North, Oak Lawn, IL 60453 | 2020-03-26 |
1972066751 | Amanda Mroczek | Family Medicine | 9555 52nd Avenue, Suite F, Oak Lawn, IL 60453 | 2019-04-09 |
1013479955 | Leah Rae Prager | Physician Assistant | 4400 W. 95th St., Attn: Pediatric General Surgery, Oak Lawn, IL 60453 | 2019-04-01 |
1659833473 | Chelsea Sumida Gipson | Family Medicine | 9555 South 52nd Avenue, Suite F, Oak Lawn, IL 60453 | 2019-04-01 |
1518427418 | Robert Lindgren | Family Medicine | 9555 S. 52nd Ave., Suite F, Oak Lawn, IL 60453 | 2019-03-25 |
1154886695 | Stephanie Anne Comer | Social Worker | 10102 South Cicero Avenue, Suite C, Oak Lawn, IL 60453 | 2019-02-08 |
1700360070 | Brian L Lee | Counselor | 8938 S Ridgeland Avenue Suite 100, Oak Lawn, IL 60453 | 2018-09-21 |
1679085245 | International Dental of Oak Lawn | Clinic/Center | 9539 S Cicero Ave, Oak Lawn, IL 60453 | 2017-11-03 |
1124538301 | Kavitha Rajendran | Physician Assistant | 5851 W. 95th Street, Suite 300, Oak Lawn, IL 60453 | 2017-10-02 |
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Taxonomy Code | 246ZC0007X |
Grouping | Technologists, Technicians & Other Technical Service Providers |
Classification | Specialist/Technologist, Other |
Specialization | Surgical Assistant |
A surgical assistant is a skilled practitioner who has undergone formalized education and training as a surgical assistant. The surgical assistant performs surgical functions that include, but are not limited to: retracting, manipulating, suturing, clamping, cauterizing, litigating, and tying tissue; suctioning, irrigating and sponging; positioning the patient; closure of body planes and skin; and participating in hemostasis and volume replacement. Surgical assistants are certified and registered or licensed by the state, or, in states without licensure, certified as surgical assistants by completing appropriate education and training. |
Notes: Source: Association of Surgical Assistants, 2014. [7/1/2014: title modified, definition modified] http://www.surgicalassistant.org/index.php/surgical-assisting Additional Resources: National Surgical Assistant Association, www.nsaa.net. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1558605451 | Jorge Ramon Llobet-arce | Specialist/Technologist, Other | 9941 Mayfield Ave, Oak Lawn, IL 60453-3769 | 2012-11-15 |
1548769466 | Laura Bergquist | Specialist/Technologist, Other | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2018-02-06 |
1487191813 | Ahmad Firas Allahham | Specialist/Technologist, Other | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2017-01-24 |
1811264260 | Michael Huley | Specialist/Technologist, Other | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2011-11-29 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1568072288 | Jaime Viramontes Jr. | Specialist/Technologist, Other | 2725 Technology Dr, Lombard, IL 60148-5675 | 2020-08-06 |
1215545660 | Ghirri Health Care Inc | Specialist/Technologist, Other | 9101 Falcon Ridge Dr, Bridgeview, IL 60455-2608 | 2020-07-21 |
1649896606 | Eric Dupaya | Specialist/Technologist, Other | 6432 S Eberhart Ave, Chicago, IL 60637-3325 | 2020-06-24 |
1508482027 | Juan Carlos Diaz | Specialist/Technologist, Other | 1433 W Flournoy St Apt 3f, Chicago, IL 60607-3213 | 2020-06-20 |
1528682275 | Alan George | Specialist/Technologist, Other | 606 N Van Auken St, Elmhurst, IL 60126-1947 | 2020-05-28 |
1881215416 | Brianne O'leary | Specialist/Technologist, Other | 2413 Sunrise Cir, Aurora, IL 60503-6757 | 2020-05-05 |
1669006433 | Michael Howard Keller | Specialist/Technologist, Other | 414 Chapel St, Marengo, IL 60152-3016 | 2020-03-02 |
1205487543 | Muneif Abusaleh | Specialist/Technologist, Other | 10536 Forest Ln, Chicago Ridge, IL 60415-1820 | 2019-09-27 |
1831752773 | Bienvenido Camacho | Specialist/Technologist, Other | 7900 W Deerwood Dr, Palos Park, IL 60464-2155 | 2019-04-16 |
1992278196 | Deangela Roberson | Specialist/Technologist, Other | 1212 N. Lasalle, Ste 100/ Surgery Center, Chicago, IL 60610 | 2019-01-10 |
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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.