NPIMap

Individual provider Active NPI

Lyndsey Ann Rodabaugh

  • Medical Physician Assistant
  • Suwanee, GA
National Provider Identifier
1326672668
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
2601 Northlake Dr
Suwanee, GA 30024-2942
Phone
(770) 682-2364
NPI assigned
Feb 25, 2020
Last updated
Mar 23, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

2601 Northlake Dr
Suwanee, GA 30024-2942

Mailing address

PO Box 720006
Norman, OK 73070-4006

Other practice location 1

809 S Walnut St
Stillwater, OK 74074-4226
Phone (405) 742-4936

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210413000992 OK Practitioner - Physician Assistant 9234547290 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

417 Fairview Ave
Ponca City, OK 74601-1923
Phone (580) 762-3770

801 S Walnut St
Cimarron Urology
Stillwater, OK 74074-4226
Phone (405) 742-5847

809 S Walnut St
Stillwater, OK 74074-4226

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.91 of 100Reported as apm
Quality
76.55
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4495OKMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Stillwater Medical Center Authority CurrentSince Feb 1, 2021 Accepting new patients
Stillwater Medical Center Authority CurrentSince Feb 1, 2021 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Stillwater Medical Center Authority Past Accepting new patients
Stillwater Medical Center Physicians Past Accepting new patients

Locations

417 Fairview Ave
Ponca City, OK 74601
Phone (580) 762-3770

610 S Walnut St
Stillwater, OK 74074
Phone (405) 533-2060

809 S Walnut St
Stillwater, OK 74074
Phone (405) 533-5041

Interoperability endpoints

  • Direct secure messaging: lyndsey.rodabaugh.p1@direct.smc.nextgenshare.com

Organizations & group practices 5

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 4

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": "1582588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1326672668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 720006",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730704006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 NORTHLAKE DR",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242942",
            "telephone_number": "770-682-2364"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "809 S Walnut St",
            "address_purpose": "LOCATION",
            "city": "Stillwater",
            "state": "OK",
            "postal_code": "740744226",
            "country_code": "US",
            "telephone_number": "405-742-4936",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODABAUGH",
        "first_name": "LYNDSEY",
        "middle_name": "ANN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-25",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suwanee, GA

Sources for this page

Verify at the official NPI Registry.