Tiffany D Bowerman, PA-C
Individual provider Active NPI Surgical Physician Assistant · Rome, GA
NPI 1306854005 · NPPES record last updated Oct 15, 2010
Key facts
- NPI
- 1306854005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- 004084 (GA)
- Practice address
- 100 Three Rivers Dr NE
Rome, GA 30161-4999 - Phone
- (706) 292-0040
- Fax
- (706) 378-0556
- NPI assigned
- Aug 4, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Rome Orthopaedic Center PC
Practice addresses (Care Compare)
100 Three Rivers Dr NE
Rome, GA 30161-4999
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040406000634 | GA | Practitioner - Physician Assistant | 2668465675 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rome Orthopaedic Clinic ASC, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 004084 | GA | Yes |
Addresses
Primary practice location
100 Three Rivers Dr NE
Rome, GA 30161-4999
Mailing address
100 Three Rivers Dr NE
Rome, GA 30161-4999
Phone (706) 292-0040
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 480481221C | Medicaid | GA | |
| 480481221D | Medicaid | GA | |
| 480481221A | Medicaid | GA |
Other names
- Tiffany D Holloway
Other providers in Rome, GA
- Boundless Therapy Services, LLC
- Amine Bourbia
- Alan Lee Bowen
- David Bowen
- Scott G Bowerman
- Abigail Faith Bowles
- Julianne Bowling
- Beth M Bowman
- Heather Nicole Bowman
- Jenell Denene Bowman
All providers in Rome, GA · Surgical Physician Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.