Individual provider Active NPI

Ethan Wade Tolbert, M.D.

  • Hematology & Oncology Physician
  • Atlanta, GA
National Provider Identifier
1255537239
Registry record updated Aug 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
46265 Issued in GA
Practice address
550 Peachtree St NE
Suite 1185
Atlanta, GA 30308-2247
Phone
(404) 223-0792
Fax
(404) 223-5815
NPI assigned
Jun 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 46265 GA Primary

Addresses

Primary practice location

550 Peachtree St NE
Suite 1185
Atlanta, GA 30308-2247

Mailing address

1835 Savoy Dr
Suite 300
Atlanta, GA 30341-1072
Phone (404) 223-0792

Other identifiers 1

IdentifierTypeStateIssuer
463493784DMedicaidGA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ethan.tolbertmd.p1@direct.gacancer.nextgenshare.com Direct

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090114000413 GA Practitioner - Hematology/Oncology 4284797465 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
University of Tennessee, HSC, College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
NSH Cancer Institute Professional Services G LLCGroup PAC ID 0840443164, 115 clinicians

Practice addresses (Care Compare)

1045 Southcrest Dr
Suite 200
Stockbridge, GA 30281-6113
Phone (678) 289-0549

550 Peachtree St NE
Suite 1185
Atlanta, GA 30308-2236
Phone (404) 223-0792

550 Peachtree St NE
Suite 7200
Atlanta, GA 30308-2247
Phone (404) 686-2270

Hospital & facility affiliations

  • Northside Hospital Hospital, Atlanta, GA, CCN 110161
  • Emory University Hospital Midtown Hospital, Atlanta, GA, CCN 110078
  • Emory Decatur Hospital Hospital, Decatur, GA, CCN 110076
  • Saint Joseph'S Hospital of Atlanta, Inc Hospital, Atlanta, GA, CCN 110082
  • Emory University Hospital Hospital, Atlanta, GA, CCN 110010

Merit-based Incentive Payment System (MIPS)

Final score
71.19 of 100Reported as group
Quality
69.24
Improvement activities
40
Cost
51.37

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
46265GAMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
NSH Cancer Institute Professional Services G, LLC Hematology & Oncology CurrentSince Jan 1, 2013 Accepting new patients
NSH Cancer Institute Professional Services G LLC CurrentSince Jan 1, 2013 Accepting new patients
NSH Cancer Institute Professional Services G, LLC Hematology & Oncology Past Accepting new patients
Northside Imaging LLC Past Accepting new patients

Locations

1835 Savoy Dr
Ste 300
Atlanta, GA 30341
Phone (678) 288-9555

550 Peachtree St NE
Ste 1185
Atlanta, GA 30308
Phone (404) 223-0792

6300 Hospital Pkwy
Ste 300
Johns Creek, GA 30097
Phone (770) 623-8965

1045 Southcrest Dr
Ste 200
Stockbridge, GA 30281
Phone (678) 289-0549

Organizations & group practices 4

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 6

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": "1182816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597708800000",
    "number": "1255537239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 SAVOY DR",
            "address_2": "SUITE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303411072",
            "telephone_number": "404-223-0792",
            "fax_number": "404-223-5815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 PEACHTREE ST NE",
            "address_2": "SUITE 1185",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082247",
            "telephone_number": "404-223-0792",
            "fax_number": "404-223-5815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLBERT",
        "first_name": "ETHAN",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-26",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "GA",
            "license": "46265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "463493784D",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ethan.tolbertmd.p1@direct.gacancer.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "550 Peachtree St NE",
            "address_2": "Suite 1185",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303082247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.