Individual provider Active NPI

Andrew Montalvo

  • Anesthesiologist Assistant
  • Atlanta, GA
National Provider Identifier
1760960496
Registry record updated Aug 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
Practice address
5671 Peachtree Dunwoody Rd
Atlanta, GA 30342-5000
Phone
(404) 257-1415
NPI assigned
Aug 3, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2018

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 Primary

Addresses

Primary practice location

5671 Peachtree Dunwoody Rd
Atlanta, GA 30342-5000

Mailing address

4612 Saddle Gate LN
Acworth, GA 30101-5287
Phone (770) 296-9197

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181113001758 GA Practitioner - Anesthesiology Assistant 4183978018 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Specialists in Anesthesia, P.C.Group PAC ID 9830170059, 112 clinicians

Practice addresses (Care Compare)

5665 Peachtree Dunwoody Rd
Atlanta, GA 30342-1764
Phone (404) 257-1415

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
009014GAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Specialists in Anesthesia, P.C. Anesthesiologist Assistant CurrentSince Oct 1, 2018 Accepting new patients

Locations

5665 Ptree Dunwoody Rd NE
Sandy Springs, GA 30342
Phone (678) 843-7001

5671 Ptree Dunwoody
Sandy Springs, GA 30342
Phone (404) 255-1030

5671 Ptree Dunwoody Rd NE
Ste 800
Sandy Springs, GA 30342
Phone (404) 257-1415

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1533254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533254400000",
    "number": "1760960496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4612 SADDLE GATE LN",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301015287",
            "telephone_number": "770-296-9197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5671 PEACHTREE DUNWOODY RD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303425000",
            "telephone_number": "404-257-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTALVO",
        "first_name": "ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-03",
        "last_updated": "2018-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2018; 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.