NPIMap

Organization Active NPI

Northwest ENT Associates, PC

  • Otolaryngology/Facial Plastic Surgery Physician
  • Marietta, GA
National Provider Identifier
1821176967
Registry record updated Sep 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
Legal business name
NORTHWEST ENT ASSOCIATES, PC
Practice address
80 Lacy St NW
Marietta, GA 30060
Phone
(770) 427-0368
Fax
(678) 581-5969
NPI assigned
Nov 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2012

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

Authorized official

Name
Mr. Carlos M. Egea
Title
Administrator
Phone
(770) 427-0368

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Y00000X 36884 GA
Otolaryngology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Y00000X 31970 GA
Otolaryngology/Facial Plastic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207YX0905X 041239 GA
Otolaryngology/Facial Plastic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207YX0905X Primary

Addresses

Primary practice location

80 Lacy St NW
Marietta, GA 30060

Mailing address

80 Lacy St NW
Marietta, GA 30060
Phone (770) 427-0368

Other identifiers 8

IdentifierTypeStateIssuer
00403851EMedicaidGA
10041532MedicaidGA
00868524BMedicaidGA
00553385CMedicaidGA
303310MedicaidGA
310744MedicaidGA
310745MedicaidGA
582064647MedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080521000553 GA Part B Supplier - Clinic/Group Practice 2264498807 Receives reassigned benefits from 15 practitioners
Practice locations: Atlanta, GA; Woodstock, GA; Marietta, GA; Cartersville, GA; Canton, GA

National Provider Directory

National Provider Directory

Locations

15 Medical Dr NE
Ste 303
Cartersville, GA 30121

5357 Covenant Dr
Cartersville, GA 30121

15 Medical Dr NE
Ste 300
Cartersville, GA 30121
Phone (470) 737-1694

960 Woodstock Pkwy
Ste 110
Woodstock, GA 30188

110 Highland Center Dr
Columbia, SC 29203
Phone (803) 274-1148

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348790400000",
    "number": "1821176967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 LACY ST NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30060",
            "telephone_number": "770-427-0368",
            "fax_number": "678-581-5969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 LACY ST NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30060",
            "telephone_number": "770-427-0368",
            "fax_number": "678-581-5969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST ENT ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2012-09-28",
        "status": "A",
        "authorized_official_last_name": "EGEA",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "770-427-0368",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "36884",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "31970",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "GA",
            "license": "041239",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00403851E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10041532",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00868524B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00553385C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "303310",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "310744",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "310745",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "582064647",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.