NPIMap

Individual provider Active NPI

Otto Goyco

  • Internal Medicine Physician
  • Cumming, GA
National Provider Identifier
1013990431
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
042473 Issued in GA
Practice address
900 Sanders Rd
Suite B
Cumming, GA 30041-5960
Phone
(770) 781-8840
Fax
(770) 781-8098
NPI assigned
Nov 21, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 042473 GA Primary

Addresses

Primary practice location

900 Sanders Rd
Suite B
Cumming, GA 30041-5960

Mailing address

4074 Bogan Bluff LN
Buford, GA 30519-4501
Phone (678) 482-6886

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060329000417 GA Practitioner - Internal Medicine 8325056575 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians

Practice addresses (Care Compare)

100 Mountain View Dr
Suite 100
Cumming, GA 30040-2434
Phone (770) 889-2163

3340 Paddock Pkwy
Suwanee, GA 30024-9119
Phone (678) 679-6210

3350 Paddocks Pkwy
Suwanee, GA 30024-9119
Phone (678) 474-9633

3380 Paddocks Pkwy
Suwanee, GA 30024-9119
Phone (678) 474-9633

900 Sanders Rd B
Cumming, GA 30041-5960
Phone (770) 781-8840

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.22 of 100Reported as individual
Quality
90.58
Promoting interoperability
78
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
042473GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Primary Care Professional Services, LLC CurrentSince Nov 1, 2013 Accepting new patients
Northside Primary Care Professional Services,LLC CurrentSince Nov 1, 2013 Accepting new patients
Morehouse Healthcare, Inc. Internal Medicine PastSince Jul 1, 2012 Accepting new patients

Locations

1080 Sanders Rd
Ste 100
Cumming, GA 30041
Phone (770) 781-8840

900 Sanders Rd
#B
Cumming, GA 30041
Phone (770) 781-8840

1285 Upper Hembree Rd
Ste 205
Roswell, GA 30076
Phone (770) 521-1587

3350 Paddocks Pkwy
Suwanee, GA 30024
Phone (678) 474-9633

3350 Paddocks Pkwy
#3350A
Suwanee, GA 30024
Phone (678) 474-9633

Networks

  • FL HMO

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013990431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4074 BOGAN BLUFF LN",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305194501",
            "telephone_number": "678-482-6886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SANDERS RD",
            "address_2": "SUITE B",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300415960",
            "telephone_number": "770-781-8840",
            "fax_number": "770-781-8098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOYCO",
        "first_name": "OTTO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "042473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.