Bobby Joel Treadwell Jr., PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

5730 Issued in GA

Practice address

4550 Cobb Parkway North NW
Suite 309B
Acworth, GA 30101-4180

Phone

(770) 917-6795

Fax

(770) 529-9077

NPI assigned

Mar 2, 2012

Last updated

Oct 6, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.93 of 100Reported as apm

Quality

82.14

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: btreadwell70593@directwellstar.org

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.

• Wellstar Medical Group, LLC

  dba WellStar Family Medicine ACW

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment Care Compare group
• Pinnacle Orthopaedics & Sports Medicine Specialists LLC

  • Specialist
  • Marietta, GA
  • NPI 1194815175
  Medicare reassignment
• Pinnacle Orthopaedics & Sports Medicine Specialists LLC

  • Specialist
  • Marietta, GA
  • NPI 1003367707
  NPD
• Wellstar Medical Group, LLC

  dba WellStar Infectious Disease

  • Infectious Disease Physician
  • Marietta, GA
  • NPI 1255626941
  NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD

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

{
    "created_epoch": "1330646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444089600000",
    "number": "1033483458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 COBB PARKWAY NORTH NW",
            "address_2": "SUITE 309B",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301014180",
            "telephone_number": "770-917-6795",
            "fax_number": "770-529-9077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 COBB PARKWAY NORTH NW",
            "address_2": "SUITE 309B",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301014180",
            "telephone_number": "770-917-6795",
            "fax_number": "770-529-9077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TREADWELL",
        "first_name": "BOBBY",
        "middle_name": "JOEL",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-02",
        "last_updated": "2015-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "5730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8101943",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Giovanna Tomassoni, RN
• Tooth and Tox
• Deborah Louise Torell, OTR, LPC, LMFT
• Torn Counseling and Recovery Centers, LLC
• Total Comfort Home Care LLC
• Triinty Psychiatry and Mental Wellness, LLC
• John Joseph Trimble III, MD
• Trinity Palliative Care of Ga
• Trinity Rehabilitation Services, Inc
• Cheryl Ashley Trowell, M.D.

• Surgical Physician Assistant in Acworth, GA
• Providers in Acworth, GA by specialty
• Surgical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.