MONTGOMERY COUNTY MEMORIAL HOSPITAL – Internal Medicine Physician, NPI 1265405310
Internal Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MONTGOMERY COUNTY MEMORIAL HOSPITAL
2301 EASTERN AVE
RED OAK, IA 515661305
Phone: (712) 623-7000
Fax: (712) 623-7224
Type: Location
498, Red Fox Court, Grand Junction, Mesa County, Colorado, 81504, United States
RED OAK, IA 515660498
Phone: (712) 623-7000
Fax: (712) 623-7224
Type: Mailing
Montgomery County Memorial Hospital, 2301, Eastern Avenue, Red Oak, Montgomery County, Iowa, 51566, United States
RED OAK, IA 515661305
Phone: (712) 623-7000
Fax: (712) 623-7224
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-01-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2026-01-31 (130 days ago).
Enrollment records
2
Earliest due date
2026-01-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20031211000423 | O | Clinic/Group Practice | IA | 2026-01-31 |
| O20210108002274 | O | Clinic/Group Practice | NE | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 51566)
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