NPIMap

Individual provider Active NPI

Amy Theobald Colon, PA-C

  • Medical Physician Assistant
  • Alpharetta, GA
National Provider Identifier
1164988143
Registry record updated Aug 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
9156 Issued in GA
Practice address
3400C Old Milton Pkwy Ste 270
Alpharetta, GA 30005-4438
Phone
(770) 442-1911
NPI assigned
Feb 14, 2019
Last updated
Aug 27, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 27, 2020

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 9156 GA Primary

Addresses

Primary practice location

3400C Old Milton Pkwy Ste 270
Alpharetta, GA 30005-4438

Mailing address

3400 Old Milton Pkwy Ste C270
Alpharetta, GA 30005-4414
Phone (704) 421-9117

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address acolon374759@directwellstar.org

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
I20200507001901 GA Practitioner - Physician Assistant 3072844737 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

2500 Hospital Blvd
Suite 340
Roswell, GA 30076-4977
Phone (770) 740-1753

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince May 1, 2020 Accepting new patients
Wellstar Medical Group, LLC CurrentSince May 1, 2020 Accepting new patients
Southeast Medical Group, P.C. PastSince Aug 1, 2012 Accepting new patients
Northside Womens Group LLC Past Accepting new patients
Southeast Medical Group, P.C. Medical PastSince Jan 1, 2022 Accepting new patients

Locations

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

805 Sandy Plains Rd
Marietta, GA 30066
Phone (770) 792-1616

2500 Hospital Blvd
Ste 340
Roswell, GA 30076
Phone (470) 956-4590

120 Stonebridge Pkwy
Ste 440
Woodstock, GA 30189
Phone (770) 250-7199

Interoperability endpoints

  • Direct secure messaging: acolon374759@directwellstar.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/DIJIBA

Organizations & group practices 7

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.

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": "1550102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598486400000",
    "number": "1164988143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 OLD MILTON PKWY STE C270",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300054414",
            "telephone_number": "704-421-9117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400C OLD MILTON PKWY STE 270",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300054438",
            "telephone_number": "770-442-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLON",
        "first_name": "AMY",
        "middle_name": "THEOBALD",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-14",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "9156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "acolon374759@directwellstar.org",
            "affiliation": "N",
            "address_1": "3400C Old Milton Pkwy Ste 270",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300054438",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

Verify at the official NPI Registry.