Ae Mary Vilayvong Irwin, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN145963 Issued in GA

Practice address

380 Hospital Dr Ste 320
Macon, GA 31217-8007

Phone

(478) 750-8606

NPI assigned

Jul 16, 2019

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 names 1

• Ae Mary Vilayvong Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Georgia Neurosurgical Institute, P.C.

  • Neurological Surgery Physician
  • Macon, GA
  • NPI 1972558336
  Medicare reassignment NPD
• Piedmont Providers LLC

  • Internal Medicine Physician
  • Jasper, GA
  • NPI 1548273592
  Medicare reassignment NPD
• Synergetic Healings LLC

  • Clinical Social Worker
  • Gray, GA
  • NPI 1831967884
  NPD (past)

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

{
    "created_epoch": "1563235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669680000000",
    "number": "1306498605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 PINE ST STE 880",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312017525",
            "telephone_number": "478-743-7092",
            "fax_number": "478-743-6293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 HOSPITAL DR STE 320",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312178007",
            "telephone_number": "478-750-8606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "840 Pine St Ste 880",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312017525",
            "country_code": "US",
            "telephone_number": "478-743-7092",
            "fax_number": "478-743-6293",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IRWIN",
        "first_name": "AE MARY",
        "middle_name": "VILAYVONG",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-16",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "GA",
            "license": "RN110412",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN145963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AE MARY",
            "last_name": "VILAYVONG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• James V. Intorcia, A.T.
• Stephanie Garrett Intorcia, APRN
• Maryam Irfan
• Anthony Irlik
• Gera Lynn Irvine, LPC
• Jennifer Irwin
• Haleigh Grace Isanhart, MD
• Nazrul Islam, M.D.
• Noel Raymund Israel, MD
• It's All Things ABA

• Nurse Practitioner in Macon, GA
• Providers in Macon, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.