Beverly Jean Cadwallader, PA-C
Individual provider Active NPI Medical Physician Assistant · Eatonton, GA
NPI 1003232265 · NPPES record last updated Feb 9, 2023
Key facts
- NPI
- 1003232265
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 8792 (GA)
- Practice address
- 1129 Lake Oconee Pkwy Ste 104
Eatonton, GA 31024-9581 - Phone
- (762) 220-1962
- Fax
- (762) 220-1961
- NPI assigned
- Mar 12, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 10
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Oconee Valley Healthcare Inc
Practice addresses (Care Compare)
803 S Main St
Greensboro, GA 30642-1211
Phone (706) 453-1201
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190514002580 | GA | Practitioner - Physician Assistant | 6709129794 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8792 | GA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oconee Valley Healthcare Inc | Current | Accepting new patients | |
| Oconee Valley Healthcare Inc | Current |
Accepting new patients | |
| Lake Oconee Medical Associates LLC | Past |
Accepting new patients | |
| Pacific Perinatal Institute | Past |
Accepting new patients | |
| Reddy Urgent Care - Royston LLC | Past | Accepting new patients |
Locations
803 S Main St
Greensboro, GA 30642
Phone (706) 453-1201
1040 Park Dr
Greensboro, GA 30642
Phone (706) 453-4945
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
- beverly.cadwallader.1@15507.direct.athenahealth.com
- https://api.platform.athenahealth.com/15507/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 8792 | GA | Yes |
Addresses
Primary practice location
1129 Lake Oconee Pkwy Ste 104
Eatonton, GA 31024-9581
Mailing address
1129 Lake Oconee Pkwy Ste 104
Eatonton, GA 31024-9581
Phone (762) 220-1962
Other names
- Beverly Gallati
Other providers in Eatonton, GA
- Bridgewater Family Practice, PC
- Darshell Williams Brown
- Thomas L Brown
- Marjorie Vining Butler
- Jenifer Byrd
- Jennifer Maureen Carawan
- Cardiac Disease Specialists, PC
- Cardiology Care Clinic, LLC
- Cardiology Care Clinic, LLC
- Caring Hearts Home Healthcare, LLC
All providers in Eatonton, GA · Medical Physician Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.