Active NPI
David W Retterbush, M.D.
- Surgery Physician
- Valdosta, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 20145
- 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
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 |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000193278A | Medicaid | GA |
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
Enrollment records 1
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
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 100
- Promoting interoperability
- 100
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 41 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 1-10 |
| Removal of tissue | 11 |
| Removal of skin lesions | 1-10 |
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SGMC Physician Network Inc | Surgery | Current | 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.
-
- Emergency Medicine Physician
- Valdosta, GA
- NPI 1457648313
-
- Multi-Specialty Clinic/Center
- Valdosta, GA
- NPI 1114740362
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Valdosta, GA
- NPI 1144096553
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; 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.