Matthew Soberano, D.O.

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

91572 Issued in GA

Practice address

690 Dallas Hwy Ste 101
Villa Rica, GA 30180-1262

Phone

(770) 459-0620

NPI assigned

Feb 12, 2017

Last updated

Nov 2, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Specialty

Allergy/ImmunologyAlso: Internal Medicine

Education

Lake Erie College of Osteopathic Medicine, Erie, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Center for Allergy and Asthma of Georgia PCGroup PAC ID 2062460785, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Center for Allergy & Asthma of Georgia PC

  • Allergy & Immunology Physician
  • Villa Rica, GA
  • NPI 1578504536
  Medicare reassignment Care Compare group NPD
• Center for Allergy and Asthma Southern Crescent

  • Allergy & Immunology Physician
  • Peachtree City, GA
  • NPI 1750902185
  NPD (past)

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

{
    "created_epoch": "1486857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1386183218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10013 VINEYARD LAKE RD E",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322561485",
            "telephone_number": "904-923-3135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 DALLAS HWY STE 101",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801262",
            "telephone_number": "770-459-0620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOBERANO",
        "first_name": "MATTHEW",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-12",
        "last_updated": "2023-11-02",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "GA",
            "license": "91572",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "91572",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Small Town Eyecare Partners, LLC (Vision Source Villa Rica)
• Andrew C Smith, DPT
• Kensey Alene Smith, OTA
• Melanie Woodall Smith, M.S., CCC-A
• Tanisha Lavette Smith
• Soma Anesthesia Services LLC
• Courtney Spann
• Jillian Spears
• Rebecca Ann Stanard, PH.D. LPC
• Tiffany L Stanfill, MD

• Allergy & Immunology Physician in Villa Rica, GA
• Providers in Villa Rica, GA by specialty
• Allergy & Immunology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.