NPIMap

Individual provider Active NPI

Amit V. Tibrewala, MD

  • Cardiovascular Disease Physician
  • Cumming, GA
National Provider Identifier
1720275233
Registry record updated Dec 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
068325 Issued in GA
Practice address
1505 Northside Forsyth Dr
Ste 3600
Cumming, GA 30041
Phone
(770) 343-8565
Fax
(770) 781-3559
NPI assigned
Sep 28, 2007
Last updated
Dec 15, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X ME 108835 FL
Cardiovascular Disease Physician 207RC0000X 068325 GA Primary

Addresses

Primary practice location

1505 Northside Forsyth Dr
Ste 3600
Cumming, GA 30041

Mailing address

873 Brightwater Cir
Maitland, FL 32751-4233
Phone (407) 284-1914

Other identifiers 4

IdentifierTypeStateIssuer
003125698MMedicaidGA
003125698NMedicaidGA
003125698DMedicaidGA
003125698LMedicaidGA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address NorthsideHeart@Northside.gwaydirect.com Direct

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
I20120806000330 GA Practitioner - Internal Medicine 7618035445 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northside Cardiovascular Professional Services, LLCGroup PAC ID 9739189838, 143 clinicians

Practice addresses (Care Compare)

1505 Northside Forsyth Dr
Suite 3600
Cumming, GA 30041
Phone (770) 343-8565

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.82 of 100Reported as group
Quality
67.82
Promoting interoperability
77
Improvement activities
40
Cost
77.43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME 108835FLMDCardiovascular Disease Physician
068325GAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Cardiovascular Professional Services, LLC Cardiovascular Disease CurrentSince Aug 1, 2012 Accepting new patients
Central Florida Cardiology Group PA Past Accepting new patients
Qoros Florida Cardiology Associates, P.a. Cardiovascular Disease PastSince Oct 18, 2024 Accepting new patients

Locations

1285 Upper Hembree Rd
Roswell, GA 30076
Phone (770) 343-8565

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25476/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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 5

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": "1190937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607990400000",
    "number": "1720275233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "873 BRIGHTWATER CIR",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327514233",
            "telephone_number": "407-284-1914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 NORTHSIDE FORSYTH DR",
            "address_2": "STE 3600",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "30041",
            "telephone_number": "770-343-8565",
            "fax_number": "770-781-3559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBREWALA",
        "first_name": "AMIT",
        "middle_name": "V.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-28",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME 108835",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "068325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003125698M",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003125698N",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003125698D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003125698L",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "NorthsideHeart@Northside.gwaydirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "1505 Northside Forsyth Dr",
            "address_2": "Ste 3600",
            "city": "Cumming",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.