Active NPI
Matthew Anthony Threadgill, M.D.
- Pediatrics Physician
- Augusta, GA
National Provider Identifier
1376740977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 002452
- Practice address
- 1245 Augusta West Pkwy
Augusta, GA 30909-1807 - Phone
- (706) 868-0389
- Fax
- (706) 651-0729
- NPI assigned
- Jun 28, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 002452 | GA | Primary |
Addresses
Primary practice location
1245 Augusta West Pkwy
Augusta, GA 30909-1807
Mailing address
1245 Augusta West Pkwy
Augusta, GA 30909-1807
Phone (706) 868-0389
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 286300162A | Medicaid | GA | |
| 064081 | Other | GA | GA LICENSES |
| 002452 | Other | GA | RESIDENCY TRAINING PERMIT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002452 | GA | MD | Anesthesiologist Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Augusta Pediatric Associates, P.C. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatric Adolescent Medicine Physician
- Augusta, GA
- NPI 1275593790
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279584000000",
"number": "1376740977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1245 AUGUSTA WEST PKWY",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309091807",
"telephone_number": "706-868-0389",
"fax_number": "706-651-0729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1245 AUGUSTA WEST PKWY",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309091807",
"telephone_number": "706-868-0389",
"fax_number": "706-651-0729"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THREADGILL",
"first_name": "MATTHEW",
"middle_name": "ANTHONY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-28",
"last_updated": "2010-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "002452",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "286300162A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GA LICENSES",
"identifier": "064081",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RESIDENCY TRAINING PERMIT",
"identifier": "002452",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.