Dixie Mayberry, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

9782 Issued in GA

Practice address

818 Church St NE
Marietta, GA 30060-8981

Phone

(770) 590-4190

Fax

(770) 590-4191

NPI assigned

Nov 18, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC, GA2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.93 of 100Reported as apm

Quality

82.14

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment Care Compare group
• Self Medical Group

  • Surgery Physician
  • Greenwood, SC
  • NPI 1982836847
  Medicare reassignment
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Acworth, GA
  • NPI 1568768109
  NPD
• Bon Secours Ambulatory Services - St. Francis, LLC

  • Urgent Care Clinic/Center
  • Greenville, SC
  • NPI 1124495643
  NPD
• Self Medical Group

  • Family Medicine Physician
  • Saluda, SC
  • NPI 1265971030
  NPD
• Self Medical Group

  • Diagnostic Radiology Physician
  • Greenwood, SC
  • NPI 1659839694
  NPD
• Self Medical Group

  • Gastroenterology Physician
  • Greenwood, SC
  • NPI 1841047560
  NPD (past)
• Woodruff Road Urgent Care Center, P.C.

  • Primary Care Clinic/Center
  • Powdersville, SC
  • NPI 1205475001
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1184098832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "818 CHURCH ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300608981",
            "telephone_number": "770-590-4190",
            "fax_number": "770-590-4191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 CHURCH ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300608981",
            "telephone_number": "770-590-4190",
            "fax_number": "770-590-4191"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 Academy Ave",
            "address_purpose": "LOCATION",
            "city": "Greenwood",
            "state": "SC",
            "postal_code": "296463808",
            "country_code": "US",
            "telephone_number": "864-223-8090",
            "fax_number": "864-223-4026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAYBERRY",
        "first_name": "DIXIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-18",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SC",
            "license": "2476",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "9782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2450PA",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dtimms392138@directwellstar.org",
            "affiliation": "N",
            "address_1": "818 Church St NE",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300608981",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Maximum Motion
• Maxmath Tutoring Online Inc Georgia Branch
• Hannah Joy May, PA-C
• Levi May, MD
• Nelson Henry May, MD
• Keisha Tenell Mayer, LPC
• Stephen D Mayes, HAD
• Anne Scarlett Mayfield, LAPC
• William Rodger Mayfield, M.D.
• Susan Harbison Mayne, PT

• Surgical Physician Assistant in Marietta, GA
• Providers in Marietta, GA by specialty
• Surgical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.