Individual provider Active NPI

Tamatha Rutherford, SPEECH-LANGUAGE PATH

  • Speech-Language Pathologist
  • Macon, GA
National Provider Identifier
1568514065
Registry record updated Jul 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP003659 Issued in GA
Practice address
610 3Rd St Ste 200
Macon, GA 31201-3262
Phone
(478) 334-2328
NPI assigned
Jan 17, 2007
Last updated
Jul 21, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SLP003659 GA Primary

Addresses

Primary practice location

610 3Rd St Ste 200
Macon, GA 31201-3262

Mailing address

610 3Rd St Ste 200
Macon, GA 31201-3262
Phone (478) 334-2328

Other identifiers 1

IdentifierTypeStateIssuer
543788055AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180802003180 GA Practitioner - Qualified Speech Language Pathologist 0345598660 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

610 3Rd St
Suite 200
Macon, GA 31201-3262
Phone (478) 334-2328

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SLP003659GAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Swallowing Specialists of Central Georgia, LLC Speech-Language Pathologist CurrentSince Apr 3, 2018 Accepting new patients

Locations

610 3rd St
Ste 100
Macon, GA 31201
Phone (478) 745-8205

610 3rd St
Ste 200
Macon, GA 31201
Phone (478) 334-2328

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1568514065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 3RD ST STE 200",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312013262",
            "telephone_number": "478-334-2328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 3RD ST STE 200",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312013262",
            "telephone_number": "478-334-2328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTHERFORD",
        "first_name": "TAMATHA",
        "credential": "SPEECH-LANGUAGE PATH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP003659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "543788055A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; 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.