Tabetha Broome Renner, PA-AC

Primary specialty

Anesthesiologist AssistantTaxonomy code 367H00000X

License

05414 Issued in GA

Practice address

400 Charter Blvd
Macon, GA 31210-4831

Phone

(478) 746-7577

NPI assigned

Aug 7, 2008

Last updated

Apr 13, 2022By the provider in NPPES

Sex

Female

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 7

Other names 1

• Tabetha Broome Ragin Former name

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Anesthesiology Assistant

Education

Emory University School of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Piedmont Anesthesia LLCGroup PAC ID 2163837972, 555 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Coliseum Medical Centers, LLC, Dba Hospital, Macon, GA, CCN 110164

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Piedmont Anesthesia LLC

  • Anesthesiology Physician
  • Stockbridge, GA
  • NPI 1700474244
  Medicare reassignment Care Compare group NPD
• Palmyra Professional Fees LLC

  • Certified Registered Nurse Anesthetist
  • Albany, GA
  • NPI 1437140084
  NPD (past)
• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  NPD (past)

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

• Coliseum Medical Center, LLC

  dba Piedmont Macon Medical Center

  • General Acute Care Hospital
  • Macon, GA
  • NPI 1598719643
  Care Compare affiliation

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

{
    "created_epoch": "1218067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1487810610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2564",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312032565",
            "telephone_number": "478-746-5644",
            "fax_number": "478-745-4849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 CHARTER BLVD",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312104831",
            "telephone_number": "478-746-7577"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "380 Hospital Dr",
            "address_2": "Suite 410",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "31217",
            "country_code": "US",
            "telephone_number": "478-746-5644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RENNER",
        "first_name": "TABETHA",
        "middle_name": "BROOME",
        "name_prefix": "Mrs.",
        "credential": "PA-AC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-07",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "05414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "606097755D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "606097755G",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "580628385",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01101055",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "606097755E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "606097755F",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "578310",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TABETHA",
            "last_name": "RAGIN",
            "middle_name": "BROOME",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Anesthesiologist Assistant in Macon, GA
• Providers in Macon, GA by specialty
• Anesthesiologist Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.