Individual provider Active NPI

Victor Manuel Ayulo, MD

  • Pediatrics Physician
  • Macon, GA
National Provider Identifier
1366948010
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
010661 Issued in GA
Practice address
744 1St St
Macon, GA 31201
Phone
(478) 633-7600
Fax
(478) 633-7354
NPI assigned
Apr 2, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 86764 SC
Neonatal-Perinatal Medicine Physician 2080N0001X 24912 NV
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 010661 GA Primary

Addresses

Primary practice location

744 1St St
Macon, GA 31201

Mailing address

744 1St St
Macon, GA 31201-6840
Phone (478) 633-7600

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
I20181017001889 GA Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 7416209523

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
86764SCMDPediatrics Physician
24912NVMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sunrise Hospital and Medical Center, LLC Past Accepting new patients
Pokroy Medical Group of Nevada, LTD. Pediatrics Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1366948010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 1ST ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312016840",
            "telephone_number": "478-633-7600",
            "fax_number": "478-633-7354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 1ST ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "31201",
            "telephone_number": "478-633-7600",
            "fax_number": "478-633-7354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYULO",
        "first_name": "VICTOR",
        "middle_name": "MANUEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-02",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "86764",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NV",
            "license": "24912",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "010661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.