Active NPI
Mason Todd Trebony, M.D.
- Internal Medicine Physician
- Moultrie, GA
National Provider Identifier
1407825359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 040804
- Practice address
- 9 Hospital Park
Moultrie, GA 31768-6772 - Phone
- (229) 890-1442
- Fax
- (229) 890-0782
- NPI assigned
- Mar 14, 2006
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 040804 | GA | Primary |
Addresses
Primary practice location
9 Hospital Park
Moultrie, GA 31768-6772
Mailing address
9 S Underwood St
Camilly, GA 31730
Phone (229) 454-5964
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11D0942926 | Other | GA | CLIA |
| 52670227 | Other | GA | BC/BS OF GA |
| 331639 | Other | GA | WELLCARE |
| 000752375A | Medicaid | GA | |
| 040804 | Other | GA | GA LICENSE |
| 110149299 | Other | GA | RR MEDICARE/METRAHEALTH |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 040804 | GA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690848000000",
"number": "1407825359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 S UNDERWOOD ST",
"city": "CAMILLY",
"state": "GA",
"postal_code": "31730",
"telephone_number": "229-454-5964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 HOSPITAL PARK",
"city": "MOULTRIE",
"state": "GA",
"postal_code": "317686772",
"telephone_number": "229-890-1442",
"fax_number": "229-890-0782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TREBONY",
"first_name": "MASON",
"middle_name": "TODD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2023-08-01",
"certification_date": "2023-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "040804",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLIA",
"identifier": "11D0942926",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS OF GA",
"identifier": "52670227",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "331639",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000752375A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GA LICENSE",
"identifier": "040804",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE/METRAHEALTH",
"identifier": "110149299",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moultrie, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.