NPIMap

Individual provider Active NPI

Michael Deogracias Wood, PA-C

  • Medical Physician Assistant
  • Gainesville, GA
National Provider Identifier
1093958795
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
6310 Issued in GA
Practice address
200 W Academy Street
Gainesville, GA 30501
Phone
(770) 282-8820
NPI assigned
Apr 9, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 6310 GA Primary

Addresses

Primary practice location

200 W Academy Street
Gainesville, GA 30501

Mailing address

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

Other practice location 1

743 Spring St NE
Gainesville, GA 30501-3715
Phone (770) 534-2020

Other identifiers 1

IdentifierTypeStateIssuer
003116636YMedicaidGA

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
I20111219000115 GA Practitioner - Physician Assistant 1759437957 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Florida College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Georgia Heart Institute LLCGroup PAC ID 4183848062, 127 clinicians

Practice addresses (Care Compare)

200 S Enota Dr NE
Gainesville, GA 30501-3466
Phone (770) 534-2020

743 Spring St NE
Gainesville, GA 30501-3715
Phone (770) 534-2020

Hospital & facility affiliations

  • Northeast Georgia Medical Center, Inc Hospital, Gainesville, GA, CCN 110029

Merit-based Incentive Payment System (MIPS)

Final score
88.46 of 100Reported as group
Quality
85.33
Promoting interoperability
100
Improvement activities
40
Cost
76.19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
6310GAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Em-I Medical Services, LLC Physician Assistant CurrentSince Jan 9, 2012 Accepting new patients
Northeast Georgia Heart Center Current Accepting new patients
Dolphin Emergency Physicians LLC Past Accepting new patients
Magnolia Emergency Physicians LLC Physician Assistant Past Accepting new patients
Florida Em-I Medical Services PA Past Accepting new patients
Maroon Bells Emergency Physicians LLC Past Accepting new patients
Mount Lassen Emergency Physicians LLC Past Accepting new patients
Lavender Inpatient Services LLC Past Accepting new patients

Locations

3651 Wheeler Rd
Augusta, GA 30909
Phone (706) 651-3232

5126 Hospital Dr NE
Covington, GA 30014
Phone (770) 385-4340

200 S Enota Dr NE
Ste 200
Gainesville, GA 30501
Phone (770) 534-0991

1700 Medical Way
Snellville, GA 30078
Phone (770) 978-4229

316 N Broad St
Winder, GA 30680
Phone (770) 307-5354

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 1

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": "1239235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1093958795",
    "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 W ACADEMY STREET",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30501",
            "telephone_number": "770-282-8820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "743 Spring St NE",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013715",
            "country_code": "US",
            "telephone_number": "770-534-2020",
            "fax_number": "770-534-8025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOOD",
        "first_name": "MICHAEL",
        "middle_name": "DEOGRACIAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-09",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "6310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003116636Y",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.