Individual provider Active NPI

Michael W Rayburn, P.A.

  • Physician Assistant
  • Alpharetta, GA
National Provider Identifier
1396923520
Registry record updated Dec 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
005193 Issued in GA
Practice address
3400 Old Milton Pkwy # C
Suite 425
Alpharetta, GA 30005-3707
Phone
(770) 343-8760
Fax
(770) 664-2101
NPI assigned
Feb 11, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 005193 GA Primary

Addresses

Primary practice location

3400 Old Milton Pkwy # C
Suite 425
Alpharetta, GA 30005-3707

Mailing address

3400 Old Milton Pkwy # C
Suite 425
Alpharetta, GA 30005-3707
Phone (770) 343-8760

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100903000051 GA Practitioner - Physician Assistant 7214051895 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1200 Northside Forsyth Dr
Cumming, GA 30041-7659
Phone (770) 844-3200

3340 Paddock Pkwy
Suwanee, GA 30024-9119
Phone (678) 679-6210

3350 Paddocks Pkwy
Suwanee, GA 30024-9119
Phone (678) 474-9633

3380 Paddocks Pkwy
Suwanee, GA 30024-9119
Phone (678) 474-9633

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Surgical Professional Services LLC Past Accepting new patients
Northside Primary Care Professional Services,LLC Past Accepting new patients

Organizations & group practices 4

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 2

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": "1202688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480636800000",
    "number": "1396923520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 OLD MILTON PKWY # C",
            "address_2": "SUITE 425",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300053707",
            "telephone_number": "770-343-8760",
            "fax_number": "770-664-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 OLD MILTON PKWY # C",
            "address_2": "SUITE 425",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300053707",
            "telephone_number": "770-343-8760",
            "fax_number": "770-664-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAYBURN",
        "first_name": "MICHAEL",
        "middle_name": "W",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-11",
        "last_updated": "2016-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "005193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

Verify at the official NPI Registry.