Active NPI
Kyla Rentch
- Physician Assistant
- Decatur, GA
National Provider Identifier
1366071755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 1670 Clairmont Rd
Decatur, GA 30033-4004 - Phone
- (404) 321-6111
- NPI assigned
- Apr 7, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
1670 Clairmont Rd
Decatur, GA 30033-4004
Mailing address
1377 Euclid Ave NE
Atlanta, GA 30307-1581
Phone (404) 784-6216
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: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220608002041 | GA | Order and Referring Only - Physician Assistant | 3678951340 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9797 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586217600000",
"number": "1366071755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1377 EUCLID AVE NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303071581",
"telephone_number": "404-784-6216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1670 CLAIRMONT RD",
"city": "DECATUR",
"state": "GA",
"postal_code": "300334004",
"telephone_number": "404-321-6111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENTCH",
"first_name": "KYLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-07",
"last_updated": "2020-04-07",
"certification_date": "2020-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2020; 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.