Active NPI
Ronald Reid Durbin III, MD
- Surgery Physician
- Fort Moore, GA
National Provider Identifier
1700932308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 045691
- Practice address
- 6600 Van Aalst Blvd # 2a-124
Fort Moore, GA 31905-2102 - Phone
- (762) 408-3565
- NPI assigned
- Jan 26, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 045691 | CT | Primary |
Addresses
Primary practice location
6600 Van Aalst Blvd # 2a-124
Fort Moore, GA 31905-2102
Mailing address
6600 Van Aalst Blvd # 2a-124
Fort Moore, GA 31905-2102
Phone (762) 408-3565
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2V9940 | Other | CT | HEALTHNET |
| 8221524 | Other | CT | CIGNA |
| 045691 | Other | CT | CT CARE |
| 010045691CT01 | Other | CT | ANTHEM |
| 001456913 | Medicaid | CT |
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150506002307 | GA | Order and Referring Only - General Surgery | 3173617644 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 045691 | CT | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709078400000",
"number": "1700932308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6600 VAN AALST BLVD # 2A-124",
"city": "FORT MOORE",
"state": "GA",
"postal_code": "319052102",
"telephone_number": "762-408-3565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6600 VAN AALST BLVD # 2A-124",
"city": "FORT MOORE",
"state": "GA",
"postal_code": "319052102",
"telephone_number": "762-408-3565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DURBIN",
"first_name": "RONALD",
"middle_name": "REID",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2024-02-28",
"certification_date": "2024-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CT",
"license": "045691",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "2V9940",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "8221524",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CT CARE",
"identifier": "045691",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "010045691CT01",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001456913",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Moore, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.