Luis Sirotzky, MD
Individual provider Active NPI Internal Medicine Physician · Chattahoochee Hills, GA
NPI 1124253281 · NPPES record last updated Jul 31, 2023
Key facts
- NPI
- 1124253281
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 86279 (GA)
- Practice address
- 4857 Hearn Rd
Chattahoochee Hills, GA 30268 - Phone
- (561) 236-2681
- NPI assigned
- May 19, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171113000887 | NC | Practitioner - Internal Medicine | 3173675204 | Practice locations: Corolla, NC |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86279 | GA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Conviva Medical Center Management LLC | Internal Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 86279 | GA | Yes |
Addresses
Primary practice location
4857 Hearn Rd
Chattahoochee Hills, GA 30268
Mailing address
4857 Hearn Rd
Chattahoochee Hills, GA 30268
Phone (561) 236-2681
NPI Registry JSON
{
"created_epoch": "1242691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690761600000",
"number": "1124253281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4857 HEARN RD",
"city": "CHATTAHOOCHEE HILLS",
"state": "GA",
"postal_code": "30268",
"telephone_number": "561-236-2681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4857 HEARN RD",
"city": "CHATTAHOOCHEE HILLS",
"state": "GA",
"postal_code": "30268",
"telephone_number": "561-236-2681"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIROTZKY",
"first_name": "LUIS",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-19",
"last_updated": "2023-07-31",
"certification_date": "2023-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "86279",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chattahoochee Hills, GA
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- Steve A Gorman
- Alicia M Price
- Rachel Smith
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All providers in Chattahoochee Hills, GA · Internal Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.