Individual provider Active NPI

David W Retterbush, M.D.

  • Surgery Physician
  • Valdosta, GA
National Provider Identifier
1396910337
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
20145 Issued in GA
Practice address
403 Cowart Ave
Valdosta, GA 31602-2635
Phone
(229) 244-0034
Fax
(229) 244-1871
NPI assigned
Apr 29, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 20145 GA Primary

Addresses

Primary practice location

403 Cowart Ave
Valdosta, GA 31602-2635

Mailing address

PO Box 3638
Valdosta, GA 31604-3638
Phone (229) 244-0034

Other identifiers 1

IdentifierTypeStateIssuer
000193278AMedicaidGA

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
I20080430000496 GA Practitioner - General Surgery 1456430537 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Medical College of Georgia School of Medicine, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SGMC Physician Network IncGroup PAC ID 4082036843, 128 clinicians

Practice addresses (Care Compare)

410 Connell Rd
Suite B
Valdosta, GA 31602-1898
Phone (229) 433-5558

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy41
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue11
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
SGMC Physician Network Inc Surgery CurrentSince Nov 1, 2020 Accepting new patients
SGMC Affiliated Services LLC Current Accepting new patients
Hospital Authority of Valdosta and Lowndes County Georgia Current Accepting new patients

Locations

4280 N Valdosta Rd
Valdosta, GA 31602
Phone (229) 433-7350

410 Connell Rd
Ste B
Valdosta, GA 31602
Phone (229) 244-1570

2501 N Patterson St
Valdosta, GA 31602
Phone (229) 259-4139

3230 Wildwood Plantation Cir
Valdosta, GA 31605
Phone (229) 433-4340

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209427200000",
    "number": "1396910337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3638",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316043638",
            "telephone_number": "229-244-0034",
            "fax_number": "229-244-1871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 COWART AVE",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022635",
            "telephone_number": "229-244-0034",
            "fax_number": "229-244-1871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETTERBUSH",
        "first_name": "DAVID",
        "middle_name": "W",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "20145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000193278A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.