Individual provider Active NPI

Allen P Butler, M.D.

  • Otolaryngology Physician
  • Gainesville, GA
National Provider Identifier
1326045048
Registry record updated Nov 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
52260 Issued in GA
Practice address
2406 Lighthouse Manor Dr
Gainesville, GA 30501-7401
Phone
(770) 536-4352
Fax
(770) 532-8165
NPI assigned
Jul 7, 2005
Last updated
Nov 2, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 14873R LA
Otolaryngology Physician 207Y00000X 52260 GA Primary

Addresses

Primary practice location

2406 Lighthouse Manor Dr
Gainesville, GA 30501-7401

Mailing address

2406 Lighthouse Manor Dr
Gainesville, GA 30501-7401
Phone (770) 536-4352

Other identifiers 1

IdentifierTypeStateIssuer
1151262MedicaidLA

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
I20110330000141 GA Practitioner - Otolaryngology 7719059229 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Medical College of Georgia School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Georgia OtolaryngologyGroup PAC ID 3173550464, 12 clinicians

Practice addresses (Care Compare)

2406 Lighthouse Manor Dr
Gainesville, GA 30501-7401
Phone (770) 536-4352

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.9 of 100Reported as group
Promoting interoperability
94
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14873RLAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Georgia Otolaryngology CurrentSince Mar 2, 2011 Accepting new patients
Hebert Medical Group, Apmc Otolaryngology PastSince Feb 1, 2002 Accepting new patients

Locations

1235 Friendship Rd
Ste 100
Braselton, GA 30517
Phone (770) 536-4352

2406 Lighthouse Manor Dr
Gainesville, GA 30501
Phone (404) 536-4352

Organizations & group practices 2

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 1

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": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288656000000",
    "number": "1326045048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2406 LIGHTHOUSE MANOR DR",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305017401",
            "telephone_number": "770-536-4352",
            "fax_number": "770-532-8165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2406 LIGHTHOUSE MANOR DR",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305017401",
            "telephone_number": "770-536-4352",
            "fax_number": "770-532-8165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "ALLEN",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2010-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "LA",
            "license": "14873R",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "52260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1151262",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.