Individual provider Active NPI

Phillip Patrick Rideout, MD

  • Vascular Surgery Physician
  • Gainesville, GA
National Provider Identifier
1093153116
Registry record updated Jan 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
73048 Issued in GA
Practice address
200 S Enota Dr NE Ste 360
Gainesville, GA 30501-3466
Phone
(770) 219-4000
NPI assigned
Jun 11, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 6088 GA
Vascular Surgery Physician 2086S0129X 73048 GA Primary

Addresses

Primary practice location

200 S Enota Dr NE Ste 360
Gainesville, GA 30501-3466

Mailing address

PO Box 742616
Atlanta, GA 30374-2616
Phone (770) 219-8420

Other practice location 1

1924 Alcoa Hwy # U-11
Knoxville, TN 37920
Phone (865) 305-9006

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address prideout106383@nghs.gadirect.net Direct

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
I20200720000718 GA Practitioner - Vascular Surgery 9133448632 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Medical University of South Carolina College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northeast Georgia Physicians Group IncGroup PAC ID 6901898386, 884 clinicians

Practice addresses (Care Compare)

200 S Enota Dr NE
Suite 360
Gainesville, GA 30501-3466
Phone (770) 219-4000

Hospital & facility affiliations

  • Northeast Georgia Medical Center, Inc Hospital, Gainesville, GA, CCN 110029
  • Northeast Georgia Medical Center Habersham Hospital, Demorest, GA, CCN 110041
  • Northeast Georgia Medical Center Lumpkin Hospital, Dahlonega, GA, CCN 110237
  • NGMC Barrow, LLC Hospital, Winder, GA, CCN 110045
  • Northside Hospital Hospital, Atlanta, GA, CCN 110161

Merit-based Incentive Payment System (MIPS)

Final score
87.83 of 100Reported as group
Quality
80.36
Promoting interoperability
100
Improvement activities
40
Cost
79.08

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Varicose vein removal12
Leg revascularization (restoring blood flow)29
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
73048GAMDVascular Surgery Physician
6088GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Georgia Physicians Group Inc Surgery CurrentSince Aug 1, 2020 Accepting new patients
Northeast Georgia Medical Center, Inc. Past Accepting new patients

Locations

1404 River Pl
#201
Braselton, GA 30517
Phone (770) 219-9200

597 S Enota Dr NE
Gainesville, GA 30501
Phone (770) 219-8275

200 S Enota Dr NE
Ste 360
Gainesville, GA 30501
Phone (770) 219-4000

Organizations & group practices 2

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

Hospital & facility affiliations 5

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": "1370908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1093153116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742616",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742616",
            "telephone_number": "770-219-8420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S ENOTA DR NE STE 360",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013466",
            "telephone_number": "770-219-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1924 Alcoa Hwy # U-11",
            "address_purpose": "LOCATION",
            "city": "Knoxville",
            "state": "TN",
            "postal_code": "37920",
            "country_code": "US",
            "telephone_number": "865-305-9006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIDEOUT",
        "first_name": "PHILLIP",
        "middle_name": "PATRICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-11",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "6088",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "GA",
            "license": "73048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "prideout106383@nghs.gadirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "200 S Enota Dr NE Ste 360",
            "city": "Gainesville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "305013466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.