NPIMap

Individual provider Active NPI

Ashley Suzam Nordstrom, PA-C

  • Physician Assistant
  • Monticello, GA
National Provider Identifier
1568636306
Registry record updated Jan 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
005296 Issued in GA
Practice address
898 College St
Suite a
Monticello, GA 31064-1258
Phone
(706) 468-0988
Fax
(706) 468-6631
NPI assigned
Apr 14, 2008
Last updated
Jan 30, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 005296 GA Primary

Addresses

Primary practice location

898 College St
Suite a
Monticello, GA 31064-1258

Mailing address

898 College St
Suite a
Monticello, GA 31064-1258
Phone (706) 468-0988

Other identifiers 1

IdentifierTypeStateIssuer
003141276AMedicaidGA

Other names 1

  • Ashley Suzam Ravenel Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080521000863 GA Practitioner - Physician Assistant 8022187665 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jasper Health Services Inc.Group PAC ID 7214901230, 8 clinicians

Practice addresses (Care Compare)

898 A College St
Monticello, GA 31064-1258

898 College St
Monticello, GA 31064-1258
Phone (706) 468-0988

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Jasper Health Services Inc. CurrentSince Oct 31, 2013 Accepting new patients
Aylo Health, LLC Past Accepting new patients
Aylo Health, LLC Past Accepting new patients
Aylo Health, LLC Past Accepting new patients
Central Georgia Heart Center, PC Past Accepting new patients
Aylo Health, LLC Past Accepting new patients

Locations

898 College St
Monticello, GA 31064
Phone (706) 468-0988

898 College St
Ste A
Monticello, GA 31064
Phone (706) 468-0988

Organizations & group practices 7

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": "1208131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391040000000",
    "number": "1568636306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "898 COLLEGE ST",
            "address_2": "SUITE A",
            "city": "MONTICELLO",
            "state": "GA",
            "postal_code": "310641258",
            "telephone_number": "706-468-0988",
            "fax_number": "706-468-6631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "898 COLLEGE ST",
            "address_2": "SUITE A",
            "city": "MONTICELLO",
            "state": "GA",
            "postal_code": "310641258",
            "telephone_number": "706-468-0988",
            "fax_number": "706-468-6631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORDSTROM",
        "first_name": "ASHLEY",
        "middle_name": "SUZAM",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-14",
        "last_updated": "2014-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "005296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003141276A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ASHLEY",
            "last_name": "RAVENEL",
            "middle_name": "SUZAM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Monticello, GA

Sources for this page

Verify at the official NPI Registry.