Individual provider Active NPI

George Kuruvilla Pattam, PA

  • Physician Assistant
  • Gainesville, GA
National Provider Identifier
1699100073
Registry record updated Sep 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
705 Jesse Jewell Pkwy SE
Suite 200
Gainesville, GA 30501-3867
Phone
(770) 534-9014
Fax
(770) 534-9012
NPI assigned
Sep 4, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2013

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 GA Primary

Addresses

Primary practice location

705 Jesse Jewell Pkwy SE
Suite 200
Gainesville, GA 30501-3867

Mailing address

1565 Forest Brook TRL
Cumming, GA 30041-8132

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131014001067 GA Practitioner - Physician Assistant 9436383064 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Eastern Virginia Medical School, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northside CV Professional Services LLCGroup PAC ID 4880003771, 53 clinicians

Practice addresses (Care Compare)

1000 Medical Ctr Blvd
Lawrenceville, GA 30046-7694
Phone (678) 312-1000

1132 Athens Hwy
Suite 207
Grayson, GA 30017-1760
Phone (678) 389-4147

Hospital & facility affiliations

  • Northside Hospital Gwinnett Hospital, Lawrenceville, GA, CCN 110087
  • Northside Hospital Hospital, Atlanta, GA, CCN 110161

Merit-based Incentive Payment System (MIPS)

Final score
76.66 of 100Reported as group
Quality
58.46
Promoting interoperability
83
Improvement activities
40
Cost
77.92

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
006941GAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Hospital, Inc. CurrentSince Apr 1, 2023 Accepting new patients

Locations

535 Jesse Jewell Pkwy SE
Ste C
Gainesville, GA 30501
Phone (770) 531-9014

1132 Athens Hwy
Ste 207
Grayson, GA 30017
Phone (678) 312-0300

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

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 and National Provider Directory roles.

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": "1378252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378252800000",
    "number": "1699100073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1565 FOREST BROOK TRL",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300418132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 JESSE JEWELL PKWY SE",
            "address_2": "SUITE 200",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013867",
            "telephone_number": "770-534-9014",
            "fax_number": "770-534-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATTAM",
        "first_name": "GEORGE",
        "middle_name": "KURUVILLA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-04",
        "last_updated": "2013-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.