Individual provider Active NPI

Robert Allan Cibiras, PA-C

  • Physician Assistant
  • Blakely, GA
National Provider Identifier
1740479104
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
007212 Issued in GA
Practice address
11740 Columbia St
Blakely, GA 39823-2574
Phone
(229) 724-4282
Fax
(229) 724-4283
NPI assigned
Oct 22, 2007
Last updated
Oct 11, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 007212 GA Primary
Medical Physician Assistant 363AM0700X PA9101120 FL
Medical Physician Assistant 363AM0700X 3801 AZ
Medical Physician Assistant 363AM0700X PA251 AL

Addresses

Primary practice location

11740 Columbia St
Blakely, GA 39823-2574

Mailing address

11740 Columbia St
Blakely, GA 39823-2574
Phone (229) 724-4282

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080520000034 AL Practitioner - Physician Assistant 8224110408 Reassigns benefits to 2 organizations
I20141112000784 GA Practitioner - Physician Assistant 8224110408 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3801AZMDHand Physical Therapist
PA251ALMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Nes Tennessee Inc CurrentSince Jun 11, 2018 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
Lifebrite Hospital Group of Early LLC Past Accepting new patients
Lifebrite Hospital Group of Early LLC Past Accepting new patients
Stabler Clinic, P.C. Past Accepting new patients
Southwest Emergency Physicians, PLLC Past Accepting new patients

Locations

29 L V Stabler Dr
Greenville, AL 36037
Phone (334) 382-2676

1725 Pine St
Montgomery, AL 36106
Phone (334) 293-8000

315 W Hickory St
Sylacauga, AL 35150
Phone (256) 249-5000

7300 State Highway 121
Ste 370374
McKinney, TX 75070

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1605/brand/1/csg/26/fhir/r4

Organizations & group practices 9

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1740479104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11740 COLUMBIA ST",
            "city": "BLAKELY",
            "state": "GA",
            "postal_code": "398232574",
            "telephone_number": "229-724-4282",
            "fax_number": "229-724-4283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11740 COLUMBIA ST",
            "city": "BLAKELY",
            "state": "GA",
            "postal_code": "398232574",
            "telephone_number": "229-724-4282",
            "fax_number": "229-724-4283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIBIRAS",
        "first_name": "ROBERT",
        "middle_name": "ALLAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-22",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "007212",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9101120",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "3801",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AL",
            "license": "PA251",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blakely, GA

Sources for this page

Verify at the official NPI Registry.