NPIMap

Individual provider Active NPI

David A Retberg, PA-C

  • Physician Assistant
  • Flowery Branch, GA
National Provider Identifier
1700065422
Registry record updated Aug 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9308 Issued in GA
Practice address
7316 Spout Springs Rd Ste 203
Flowery Branch, GA 30542-5620
Phone
(678) 205-8387
Fax
(678) 808-1039
NPI assigned
Oct 30, 2007
Last updated
Aug 30, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2009-0013 NM
Physician Assistant 363A00000X 9308 GA Primary
Medical Physician Assistant 363AM0700X PA2009-0013 NM

Addresses

Primary practice location

7316 Spout Springs Rd Ste 203
Flowery Branch, GA 30542-5620

Mailing address

1930 Brannan Rd
McDonough, GA 30253-4310
Phone (678) 284-4040

Other identifiers 1

IdentifierTypeStateIssuer
PA2009-0013OtherNMNM LICENSE

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
I20191028002663 GA Practitioner - Physician Assistant 0941398028 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Emory Clinic IncGroup PAC ID 8820901408, 3,507 clinicians

Practice addresses (Care Compare)

1365 Clifton Rd NE
Atlanta, GA 30322-1013
Phone (404) 778-7525

2201 Henderson Mill Rd NE
Atlanta, GA 30345-2711

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.51 of 100Reported as apm
Quality
80.61
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3691AZMDOccupational Therapy Assistant
PA2009-0013NMMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Urology PA CurrentSince Sep 1, 2019 Accepting new patients
The Emory Clinic Inc CurrentSince Jun 28, 2021 Accepting new patients
Georgia Urology, PA CurrentSince Sep 1, 2019 Accepting new patients
Dermatology of New Mexico LLC PastSince Oct 13, 2019 Accepting new patients

Locations

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

101 W Ponce de Leon Ave
Decatur, GA 30030
Phone (404) 778-4889

1930 Brannan Rd
McDonough, GA 30253
Phone (678) 284-4040

900 Towne Lake Pkwy
Ste 200
Woodstock, GA 30189
Phone (678) 494-9201

Interoperability endpoints

  • Direct secure messaging: dretberg10541@ahs.direct-ci.com
  • Direct secure messaging: dretberg51720@direct.emory.org

Organizations & group practices 6

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 6

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": "1193702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567123200000",
    "number": "1700065422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 BRANNAN RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302534310",
            "telephone_number": "678-284-4040",
            "fax_number": "678-284-4076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7316 SPOUT SPRINGS RD STE 203",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305425620",
            "telephone_number": "678-205-8387",
            "fax_number": "678-808-1039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETBERG",
        "first_name": "DAVID",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-30",
        "last_updated": "2019-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2009-0013",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "9308",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "PA2009-0013",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NM LICENSE",
            "identifier": "PA2009-0013",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flowery Branch, GA

Sources for this page

Verify at the official NPI Registry.