Tricia J Storteboom, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9752 Issued in GA

Practice address

790 Church St NE
Marietta, GA 30060-7282

Phone

(770) 405-2976

Fax

(770) 988-0730

NPI assigned

Jul 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Quantum Radiology PCGroup PAC ID 4385543230, 105 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellstar North Fulton Medical Center Hospital, Roswell, GA, CCN 110198
• Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143
• Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035
• Wellstar West Georgia Medical Center Hospital, Lagrange, GA, CCN 110016

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.

• Quantum Radiology, PC

  • Diagnostic Radiology Physician
  • Marietta, GA
  • NPI 1366495988
  Medicare reassignment Care Compare group
• Northside Radiology Associates LLC

  • Diagnostic Radiology Physician
  • Atlanta, GA
  • NPI 1013960657
  Medicare reassignment
• Orlando Cancer Center Inc

  • Medical Oncology Physician
  • Orlando, FL
  • NPI 1578510582
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cobb Hospital, Inc

  • General Acute Care Hospital
  • Austell, GA
  • NPI 1467420448
  Care Compare affiliation
• Kennestone Hospital, Inc.

  • General Acute Care Hospital
  • Marietta, GA
  • NPI 1649248626
  Care Compare affiliation
• Wellstar North Fulton Hospital, Inc

  • General Acute Care Hospital
  • Roswell, GA
  • NPI 1750312997
  Care Compare affiliation
• West Georgia Medical Center, Inc.

  • General Acute Care Hospital
  • Lagrange, GA
  • NPI 1821221144
  Care Compare affiliation

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682035200000",
    "number": "1376569889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3157",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462063157",
            "telephone_number": "770-405-2976",
            "fax_number": "770-988-0730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 CHURCH ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607282",
            "telephone_number": "770-405-2976",
            "fax_number": "770-988-0730"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Johnson Ferry Rd",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303421606",
            "country_code": "US",
            "telephone_number": "404-851-8820",
            "fax_number": "404-303-3747",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STORTEBOOM",
        "first_name": "TRICIA",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-15",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104129",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9104129",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "9752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292747100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Genesis Stone
• Ilene April Stone, M.D.
• Jonathan Collier Stone
• Matthew Stone, DC
• Storiebrook Therapy & Consulting
• Lisa B Story, PH.D.
• Whitney Pfohl Stovall, LPC, NCC
• Kayla Stowe
• Jefferson Wayne Stowers, M.D.
• Chantel Strahorn

• Physician Assistant in Marietta, GA
• Providers in Marietta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.