Individual provider Active NPI

Matthew Todd Kleinbub, M.D.

  • Anesthesiology Physician
  • Augusta, GA
National Provider Identifier
1558304501
Registry record updated Jun 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
052976 Issued in GA
Practice address
1350 Walton Way
Augusta, GA 30901-2612
Phone
(706) 737-9250
Fax
(706) 733-0697
NPI assigned
Jun 14, 2006
Last updated
Jun 16, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 052976 GA Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X 052976 GA

Addresses

Primary practice location

1350 Walton Way
Augusta, GA 30901-2612

Mailing address

1824 Walton Way
Augusta, GA 30904-3804
Phone (706) 737-9250

Other identifiers 3

IdentifierTypeStateIssuer
G52976MedicaidSC
P00111540OtherGARAILROAD MEDICARE
654090702AMedicaidGA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040316000357 GA Practitioner - Anesthesiology 6709776750 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Medical College of Georgia School of Medicine, 2000
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)

1350 Walton Way
Augusta, GA 30901-2612
Phone (478) 746-7577

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
052976GAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Anesthesia LLC Anesthesiology CurrentSince Oct 9, 2022 Accepting new patients
Anesthesia and Pain Medicine Anesthesiology Past Accepting new patients

Locations

1350 Walton Way
Augusta, GA 30901
Phone (706) 722-9011

720 Saint Sebastian Way
Ste 201
Augusta, GA 30901
Phone (478) 746-7577

1133 Eagles Landing Pkwy
Stockbridge, GA 30281
Phone (678) 604-1000

Organizations & group practices 2

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.

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213574400000",
    "number": "1558304501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1824 WALTON WAY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309043804",
            "telephone_number": "706-737-9250",
            "fax_number": "706-733-0697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 WALTON WAY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309012612",
            "telephone_number": "706-737-9250",
            "fax_number": "706-733-0697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLEINBUB",
        "first_name": "MATTHEW",
        "middle_name": "TODD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2008-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "GA",
            "license": "052976",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "GA",
            "license": "052976",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G52976",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00111540",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "654090702A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.