George Thekkanattu Thomas, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

C0004724 Issued in MD

Practice address

Building 140 Campus Drive
University Health Center
College Park, MD 20742

Phone

(301) 314-8095

NPI assigned

Sep 19, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 1, 2016 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• State of Maryland - DHMH

  • Public Health or Welfare Agency
  • Cambridge, MD
  • NPI 1144298290
  NPD (past)
• University Health Center

  • Clinic/Center
  • College Park, MD
  • NPI 1508849639
  NPD (past)

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

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456185600000",
    "number": "1336499151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8163 MANDAN TER",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "207702643",
            "telephone_number": "301-247-0844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BUILDING 140 CAMPUS DRIVE",
            "address_2": "UNIVERSITY HEALTH CENTER",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "20742",
            "telephone_number": "301-314-8095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "GEORGE",
        "middle_name": "THEKKANATTU",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-19",
        "last_updated": "2016-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0004724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Movement Clinic LLC
• The Training Room Inc
• Mary Ruth Theodos
• Therapeutic Wellness, LLC
• Carolyn Grace Thomas, MS, L-ATC
• Olayinka Wuraola Thompson
• Samuel Wesley Thompson Jr., ATC
• David Tiaha
• Taylor Nicole Tilley, PT, DPT
• Therese Ngeah Tim

• Medical Physician Assistant in College Park, MD
• Providers in College Park, MD by specialty
• Medical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.