Individual provider Active NPI

Vadim Lvovich

  • Anesthesiologist Assistant
  • Jonesboro, GA
National Provider Identifier
1679685697
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
1437 Issued in GA
Practice address
405 Arrowhead Blvd
Suite C
Jonesboro, GA 30236-1254
Phone
(770) 478-9877
Fax
(770) 478-2908
NPI assigned
Aug 31, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 1437 GA Primary

Addresses

Primary practice location

405 Arrowhead Blvd
Suite C
Jonesboro, GA 30236-1254

Mailing address

5570 Arrowind Rd NW
Lilburn, GA 30047-8211
Phone (770) 717-8997

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061204000395 GA Practitioner - Anesthesiology Assistant 6204835150 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverdale Anesthesia Services LLCGroup PAC ID 2163952284, 21 clinicians

Practice addresses (Care Compare)

11 Upper Riverdale Rd SW
Riverdale, GA 30274-2615
Phone (770) 991-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1437GAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Capitol Anesthesiology, PC CurrentSince May 1, 2009 Accepting new patients
Dpi of Georgia, LLC CurrentSince Jan 5, 2019 Accepting new patients
Premier Anesthesia of Georgia LLC Anesthesiologist Assistant CurrentSince Jun 27, 2018 Accepting new patients
Riverdale Anesthesia Services LLC CurrentSince Jan 15, 2025 Accepting new patients

Locations

365 E Paces Ferry Rd NE
Atlanta, GA 30305
Phone (404) 814-0868

1336 Highway 54 W
Bldg 400
Fayetteville, GA 30214
Phone (678) 251-0200

156 Foster Dr
Spc C
McDonough, GA 30253

1000 Corporate Center Dr
Ste 180
Morrow, GA 30260
Phone (770) 968-8888

6649 Lake Dr
Morrow, GA 30260

11 Upper Riverdale Rd SW
Riverdale, GA 30274
Phone (770) 897-7277

300 Colonial Center Pkwy
Ste 100N
Roswell, GA 30076
Phone (704) 684-7609

800 Mount Vernon Hwy NE
Ste 100
Sandy Springs, GA 30328
Phone (404) 237-1770

180 N Park Trl
#200
Stockbridge, GA 30281
Phone (678) 565-1806

Organizations & group practices 4

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 1

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679685697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5570 ARROWIND RD NW",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300478211",
            "telephone_number": "770-717-8997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 ARROWHEAD BLVD",
            "address_2": "SUITE C",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302361254",
            "telephone_number": "770-478-9877",
            "fax_number": "770-478-2908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LVOVICH",
        "first_name": "VADIM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "1437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.