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Individual provider Active NPI

Shahin Etebar, MD

  • Neurological Surgery Physician
  • Columbus, GA
National Provider Identifier
1194721308
Registry record updated Oct 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
89571 Issued in GA
Practice address
1538 13TH Ave Ste B300
Columbus, GA 31901-2563
Phone
(706) 321-9300
Fax
(706) 243-1284
NPI assigned
Jun 22, 2005
Last updated
Oct 31, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 89571 GA
Neurological Surgery Physician 207T00000X G72753 CA
Neurological Surgery Physician 207T00000X 89571 GA Primary

Addresses

Primary practice location

1538 13TH Ave Ste B300
Columbus, GA 31901-2563

Mailing address

1538 13TH Ave Ste B300
Columbus, GA 31901-2563
Phone (706) 321-9300

Other practice location 1

Moody AFB
3278 Mitchell Blvd
Apo, AA 31699
Phone (229) 257-3774

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
I20210917002061 GA Practitioner - Neurosurgery 1850445123 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
University of California, Irvine, California College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SGMC Physician Network IncGroup PAC ID 4082036843, 128 clinicians

Practice addresses (Care Compare)

2409 N Patterson St
Suite 210
Valdosta, GA 31602-2512
Phone (229) 433-6002

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.26 of 100Reported as group
Quality
77.61
Promoting interoperability
99
Improvement activities
40
Cost
72.83

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion61
Laminectomy or laminotomy (partial removal of spine bones)14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G72753CAMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SGMC Affiliated Services LLC Current Accepting new patients
SGMC Physician Network Inc Family Medicine CurrentSince Jun 1, 2025 Accepting new patients
Hospital Authority of Valdosta and Lowndes County, Georgia PastSince Jun 1, 2025 Accepting new patients
Eisenhower Medical Center Past Accepting new patients
Shahin Etebar MD Inc Neurological Surgery PastSince Jan 1, 1990 Accepting new patients
Alfred C Shen Medical Corporation Neurological Surgery Past Accepting new patients

Locations

2501 N Patterson St
Valdosta, GA 31602
Phone (229) 259-4139

4280 N Valdosta Rd
Valdosta, GA 31602
Phone (229) 433-7350

Organizations & group practices 6

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 4

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": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667174400000",
    "number": "1194721308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1538 13TH AVE STE B300",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319012563",
            "telephone_number": "706-321-9300",
            "fax_number": "706-243-1284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1538 13TH AVE STE B300",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319012563",
            "telephone_number": "706-321-9300",
            "fax_number": "706-243-1284"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Moody AFB",
            "address_2": "3278 Mitchell Blvd",
            "address_purpose": "LOCATION",
            "city": "APO",
            "state": "AA",
            "postal_code": "31699",
            "country_code": "US",
            "telephone_number": "229-257-3774",
            "country_name": "United States",
            "address_type": "MIL"
        }
    ],
    "basic": {
        "last_name": "ETEBAR",
        "first_name": "SHAHIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "89571",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "G72753",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "GA",
            "license": "89571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

Verify at the official NPI Registry.