Active NPI
Shiara Vassian, PA
- Dermatology Physician
- Covington, GA
National Provider Identifier
1487763355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 003545
- Practice address
- 4155 Baker St NE
Suite 100
Covington, GA 30014-1405 - Phone
- (770) 788-0620
- Fax
- (678) 342-3327
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 003545 | GA | Primary |
Addresses
Primary practice location
4155 Baker St NE
Suite 100
Covington, GA 30014-1405
Mailing address
PO Box 945934
Atlanta, GA 30394-5934
Phone (770) 788-0620
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5909 | Other | GA | KAISER PROVIDER # |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4155 Baker St NE
Suite 100
Covington, GA 30014-1405
Phone (770) 788-0620
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 1
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.
-
- Dermatology Physician
- Covington, GA
- NPI 1679682561
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203984000000",
"number": "1487763355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 945934",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303945934",
"telephone_number": "770-788-0620",
"fax_number": "678-342-3327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4155 BAKER ST NE",
"address_2": "SUITE 100",
"city": "COVINGTON",
"state": "GA",
"postal_code": "300141405",
"telephone_number": "770-788-0620",
"fax_number": "678-342-3327"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VASSIAN",
"first_name": "SHIARA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2008-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "GA",
"license": "003545",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER PROVIDER #",
"identifier": "5909",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Covington, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 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.