Individual provider Active NPI

Gregory M Deedrick, PA-AA

  • Anesthesiologist Assistant
  • Macon, GA
National Provider Identifier
1750502662
Registry record updated Nov 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
003888 Issued in GA
Practice address
777 Hemlock St
Macon, GA 31201-2102
Phone
(866) 507-5244
Fax
(855) 851-4405
NPI assigned
May 1, 2007
Last updated
Nov 21, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 003888 GA Primary

Addresses

Primary practice location

777 Hemlock St
Macon, GA 31201-2102

Mailing address

PO Box 551420
Fort Lauderdale, FL 33355-1420
Phone (800) 243-3839

Other identifiers 5

IdentifierTypeStateIssuer
100002399AMedicaidGA
344300OtherGAWELLCARE CMO - MCCG
97WCDNQOtherGAMEDICARE PTAN
100002399AOtherGAPEACHSTATE CMO - MCCG
430079677OtherGARAILROAD MCR - MCCG

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110127000807 GA Practitioner - Anesthesiology Assistant 1850570482 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Emory University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Anesthesiology Associates of Georgia LLCGroup PAC ID 7618934779, 230 clinicians
Guardian Medical Services LLCGroup PAC ID 8325347735, 28 clinicians

Practice addresses (Care Compare)

2701 N Decatur Rd
Decatur, GA 30033-5918
Phone (678) 514-1991

777 Hemlock St
Macon, GA 31201-2102
Phone (478) 633-6399

801 W Gordon St
Thomaston, GA 30286-3426
Phone (706) 647-8111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Guardian Medical Services, LLC CurrentSince Jul 1, 2018 Accepting new patients
American Anesthesiology Associates of Georgia, LLC CurrentSince Nov 1, 2014 Accepting new patients

Locations

2701 N Decatur Rd
Decatur, GA 30033
Phone (404) 501-1000

1014 Forsyth St
Macon, GA 31201
Phone (478) 633-5800

777 Hemlock St
Macon, GA 31201
Phone (478) 474-5600

777 Hemlock St
#10
Macon, GA 31201
Phone (478) 633-1007

888 Pine St
Macon, GA 31201
Phone (478) 751-0527

801 W Gordon St
Thomaston, GA 30286
Phone (706) 647-4371

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416528000000",
    "number": "1750502662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551420",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333551420",
            "telephone_number": "800-243-3839",
            "fax_number": "855-851-4405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HEMLOCK ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012102",
            "telephone_number": "866-507-5244",
            "fax_number": "855-851-4405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEEDRICK",
        "first_name": "GREGORY",
        "middle_name": "M",
        "credential": "PA-AA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2014-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "003888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002399A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE CMO - MCCG",
            "identifier": "344300",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "97WCDNQ",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEACHSTATE CMO - MCCG",
            "identifier": "100002399A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCR - MCCG",
            "identifier": "430079677",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.