Individual provider Active NPI

Robert A. Underwood, M.D.

  • Surgery Physician
  • Marietta, GA
National Provider Identifier
1063570521
Registry record updated Nov 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
049950 Issued in GA
Practice address
598 Nancy St NW Ste 250
Marietta, GA 30060-1377
Phone
(770) 428-3713
Fax
(770) 426-0730
NPI assigned
Dec 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 1, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 049950 GA Primary

Addresses

Primary practice location

598 Nancy St NW Ste 250
Marietta, GA 30060-1377

Mailing address

598 Nancy St NW Ste 250
Marietta, GA 30060-1377
Phone (770) 428-3713

Other identifiers 1

IdentifierTypeStateIssuer
00914999AMedicaidGA

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110706000276 GA Practitioner - General Surgery 6103916770

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
049950GAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Surgical Arts, P.C Single Specialty CurrentSince Dec 5, 2007 Accepting new patients

Locations

598 Nancy St NW
Ste 250
Marietta, GA 30060
Phone (770) 428-3713

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541030400000",
    "number": "1063570521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "598 NANCY ST NW STE 250",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601377",
            "telephone_number": "770-428-3713",
            "fax_number": "770-426-0730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "598 NANCY ST NW STE 250",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601377",
            "telephone_number": "770-428-3713",
            "fax_number": "770-426-0730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNDERWOOD",
        "first_name": "ROBERT",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2018-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "GA",
            "license": "049950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00914999A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.