NPIMap

Individual provider Active NPI

Xenophon Mucciarone, D.O.

  • Emergency Medicine Physician
  • Valdosta, GA
National Provider Identifier
1801216007
Registry record updated Aug 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5101021037 Issued in MI
Practice address
300 N Patterson St
Valdosta, GA 31601-5519
Phone
(229) 433-1000
NPI assigned
Apr 26, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X R9113 TX
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 5101021037 MI Primary

Addresses

Primary practice location

300 N Patterson St
Valdosta, GA 31601-5519

Mailing address

3925 N Oak Street Ext Apt 309
Valdosta, GA 31605-7618
Phone (229) 443-1000

Other practice location 1

50 N Perry St
Pontiac, MI 48342-2217
Phone (248) 338-5392

Other practice location 2

2501 N Patterson St
Valdosta, GA 31602-1735
Phone (229) 433-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, KY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190528000466 GA Practitioner - Emergency Medicine 9830319565 Reassigns benefits to 3 organizations
I20250623001660 KY Practitioner - Emergency Medicine 9830319565 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
West Virginia School of Osteopathic Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Medical Associates IncGroup PAC ID 7012811284, 1,368 clinicians
Oldham County Emergency Physicians, LLCGroup PAC ID 3072094614, 37 clinicians
Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Practice addresses (Care Compare)

1 Audubon Plaza Dr
Louisville, KY 40217-1318
Phone (502) 636-7225

1025 New Moody LN
La Grange, KY 40031-9154
Phone (502) 222-5388

11701 Bluegrass Pkwy
Suite 100
Louisville, KY 40299-2302
Phone (502) 928-4100

Hospital & facility affiliations

  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088
  • Baptist Health Louisville Hospital, Louisville, KY, CCN 180130

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Inc CurrentSince Aug 11, 2025 Accepting new patients
Phoebe Putney Memorial Hospital Inc CurrentSince Nov 1, 2019 Accepting new patients
Community Medical Associates, Inc. CurrentSince May 20, 2025 Accepting new patients
Community Medical Associates, Inc. Emergency Medicine CurrentSince May 20, 2025 Accepting new patients
Oldham County Emergency Physicians, LLC Emergency Medicine CurrentSince Feb 15, 2026 Accepting new patients
Community Medical Associates, Inc. Current Accepting new patients
SGMC Affiliated Services LLC CurrentSince Jan 1, 2025 Accepting new patients
Phoebe Putney Memorial Hospital Inc CurrentSince Nov 1, 2019 Accepting new patients
Cep America LLC Emergency Medicine Current Accepting new patients
South Georgia Emergency Medicine Associates PC Emergency Medicine CurrentSince Dec 1, 2019 Accepting new patients
Baptist Health Medical Group Inc CurrentSince Aug 11, 2025 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

417 W 3rd Ave
Albany, GA 31701
Phone (229) 317-2207

915 Gordon Ave
Thomasville, GA 31792
Phone (229) 228-8575

520 Griffin Ave
Ste A
Valdosta, GA 31601
Phone (229) 433-7340

4256 N Valdosta Rd
Valdosta, GA 31602
Phone (229) 242-1234

2501 N Patterson St
Valdosta, GA 31602
Phone (229) 259-4139

4280 N Valdosta Rd
Valdosta, GA 31602
Phone (229) 433-7350

1025 New Moody Ln
Lagrange, KY 40031
Phone (502) 222-3335

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

3900 Kresge Way
Ste 41
Louisville, KY 40207
Phone (502) 896-1313

11701 Bluegrass Pkwy
#100
Louisville, KY 40299
Phone (502) 928-4100

1 Audubon Plaza Dr
Louisville, KY 40217
Phone (502) 634-6767

1521 Joe Battle Blvd
Ste B
El Paso, TX 79936
Phone (915) 521-7798

Organizations & group practices 11

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 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1398470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1801216007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3925 N OAK STREET EXT APT 309",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316057618",
            "telephone_number": "229-443-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N PATTERSON ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316015519",
            "telephone_number": "229-433-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50 N Perry St",
            "address_purpose": "LOCATION",
            "city": "Pontiac",
            "state": "MI",
            "postal_code": "483422217",
            "country_code": "US",
            "telephone_number": "248-338-5392",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2501 N Patterson St",
            "address_purpose": "LOCATION",
            "city": "Valdosta",
            "state": "GA",
            "postal_code": "316021735",
            "country_code": "US",
            "telephone_number": "229-433-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUCCIARONE",
        "first_name": "XENOPHON",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-26",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "R9113",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101021037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.