Individual provider Active NPI

Caroline Wolter, PA-C

  • Physician Assistant
  • Suwanee, GA
National Provider Identifier
1124505987
Registry record updated Mar 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4235 Johns Creek Pkwy
Suwanee, GA 30024-6038
Phone
(770) 442-1911
NPI assigned
Jul 25, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

4235 Johns Creek Pkwy
Suwanee, GA 30024-6038

Mailing address

378 Vista Lake Dr
Suwanee, GA 30024-7420
Phone (706) 536-9094

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220627000663 GA Practitioner - Physician Assistant 7517216542 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Mercer University School of Medicine, 2018
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

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Georgia Heart Center Current Accepting new patients
Southeast Medical Group, P.C. Past Accepting new patients

Locations

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

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DIJIBA

Organizations & group practices 3

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 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": "1532476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646179200000",
    "number": "1124505987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "378 VISTA LAKE DR",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300247420",
            "telephone_number": "706-536-9094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4235 JOHNS CREEK PKWY",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246038",
            "telephone_number": "770-442-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLTER",
        "first_name": "CAROLINE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-25",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suwanee, GA

Sources for this page

Verify at the official NPI Registry.