Hakob Grigor Davtyan, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

G54367 Issued in CA

Practice address

401 E Highland Ave
Suite 251
San Bernardino, CA 92404-3803

Phone

(909) 881-1614

Fax

(909) 881-2711

NPI assigned

Jul 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

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

Thoracic SurgeryAlso: General Surgery

Education

Un of California, Irvine, College of Medicine, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tanner Medical Group IncGroup PAC ID 2769536143, 120 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tanner Home Health Services Home health agency, Carrollton, GA, CCN 117319
• Central Home Health Care, an Amedisys Company Home health agency, Douglasville, GA, CCN 117050
• Tanner Medical Center - Carrollton Hospital, Carrollton, GA, CCN 110011

Merit-based Incentive Payment System (MIPS)

Final score

94.51 of 100Reported as apm

Quality

80.61

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hdavtyan19865@direct.emory.org

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.

• Tanner Medical Group Inc

  • Cardiovascular Disease Physician
  • Carrollton, GA
  • NPI 1396979787
  Medicare reassignment Care Compare group NPD
• The Emory Clinic Inc

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1396798229
  Medicare reassignment NPD
• Corwin Medical Group Inc Ipa

  • Exclusive Provider Organization
  • Apple Valley, CA
  • NPI 1821018433
  NPD (past)
• Dignity Health Medical Foundation

  • Multi-Specialty Clinic/Center
  • Highland, CA
  • NPI 1053653873
  NPD (past)
• Carrollton Surgical Group, P. a.

  • Surgery Physician
  • Carrollton, GA
  • NPI 1417931825
  NPD (past)
• Emory Health Care

  • Neurology Physician
  • Atlanta, GA
  • NPI 1376642751
  NPD (past)
• Primecare Medical Group

  • Internal Medicine Physician
  • Tampa, FL
  • NPI 1093720427
  NPD (past)
• TMC Children'S Healthcare of West Georgia

  • Medical Specialty Clinic/Center
  • Carrollton, GA
  • NPI 1518972348
  NPD (past)

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

• Amedisys Georgia, LLC

  • Home Health Agency
  • Douglasville, GA
  • NPI 1437117090
  Care Compare affiliation
• Tanner Medical Center, Inc

  • General Acute Care Hospital
  • Carrollton, GA
  • NPI 1801883780
  Care Compare affiliation
• TMC Home Health Inc

  • Home Health Agency
  • Carrollton, GA
  • NPI 1457376386
  Care Compare affiliation

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468281600000",
    "number": "1437180676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E HIGHLAND AVE",
            "address_2": "SUITE 251",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924043803",
            "telephone_number": "909-881-1614",
            "fax_number": "909-881-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E HIGHLAND AVE",
            "address_2": "SUITE 251",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924043803",
            "telephone_number": "909-881-1614",
            "fax_number": "909-881-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVTYAN",
        "first_name": "HAKOB",
        "middle_name": "GRIGOR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2016-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G54367",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "GA",
            "license": "031902",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "031902",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G543670",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "G54367",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL PTAN",
            "identifier": "00G543671",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "ZZZ07161Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Elizabeth Davis, ACSW, CADC-CAS
• Sherronda Davis
• Susan Nmi Davis, LMFT
• Vickie Davis
• Jahanshah Davoodifard
• Abigail Mae Dawkins
• Dawn M Terashita, PC
• Angela Lorraine Dawson, RD
• Asyia Dawson
• Jae'Kwon Kai Dawson

• Specialist in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2016; 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.