Individual provider Active NPI

Ioan Adrian Todorut

  • Physician Assistant
  • Dacula, GA
National Provider Identifier
1265123509
Registry record updated Mar 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11742 Issued in GA
Practice address
3941 Pine Gorge CT
Dacula, GA 30019-4502
Phone
(770) 865-8647
NPI assigned
May 17, 2023
Last updated
Mar 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 11742 GA Primary
Physician Assistant 363A00000X

Addresses

Primary practice location

3941 Pine Gorge CT
Dacula, GA 30019-4502

Mailing address

3941 Pine Gorge CT
Dacula, GA 30019-4502
Phone (770) 865-8647

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
I20230721000318 GA Practitioner - Physician Assistant 6305206418 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
94.51 of 100Reported as apm
Quality
80.61
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11742GAMDStudent in an Organized Health Care Education/Training Program

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1684281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709337600000",
    "number": "1265123509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3941 PINE GORGE CT",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300194502",
            "telephone_number": "770-865-8647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3941 PINE GORGE CT",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300194502",
            "telephone_number": "770-865-8647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TODORUT",
        "first_name": "IOAN",
        "middle_name": "ADRIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-17",
        "last_updated": "2024-03-02",
        "certification_date": "2024-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "11742",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dacula, GA

Sources for this page

Verify at the official NPI Registry.