Individual provider Active NPI

Neill Videlefsky, MD

  • Pediatric Cardiology Physician
  • Lawrenceville, GA
National Provider Identifier
1851300305
Registry record updated Jan 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
043298 Issued in GA
Practice address
738 Old Norcross Rd
Lawrenceville, GA 30046-4462
Phone
(404) 256-2593
NPI assigned
Aug 5, 2006
Last updated
Jan 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X 043298 GA Primary

Addresses

Primary practice location

738 Old Norcross Rd
Lawrenceville, GA 30046-4462

Mailing address

2835 Brandywine Rd Ste 300
Atlanta, GA 30341-5540
Phone (404) 256-2593

Other identifiers 1

IdentifierTypeStateIssuer
00740891AMedicaidGA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sibley@choa.gadirect.com Health Information Exchange (HIE) Children's Healthcare of Atlanta

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080811000090 GA Practitioner - Pediatric MedicinePractitioner - Cardiovascular Disease (Cardiology) 3072687987 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Cardiovascular Disease (Cardiology)
Education
Other, 1985
Medicare assignment
May accept Medicare assignment
Group practices
Children's Healthcare of Atlanta Cardiology IncGroup PAC ID 6901888395, 31 clinicians

Practice addresses (Care Compare)

60 Executive Park S NE
Suite 100
Atlanta, GA 30329-2229
Phone (404) 256-2593

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
043298GAMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Healthcare of Atlanta Cardiology Inc Pediatric Cardiology CurrentSince Oct 21, 2016 Accepting new patients

Locations

2835 Brandywine Rd
Ste 300
Atlanta, GA 30341
Phone (770) 488-9202

60 Executive Park South NE
Atlanta, GA 30329

Interoperability endpoints

  • Direct secure messaging: nvidelefsky3166@choa.gadirect.net

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, 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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611532800000",
    "number": "1851300305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2835 BRANDYWINE RD STE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303415540",
            "telephone_number": "404-256-2593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "738 OLD NORCROSS RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464462",
            "telephone_number": "404-256-2593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDELEFSKY",
        "first_name": "NEILL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "GA",
            "license": "043298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00740891A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sibley@choa.gadirect.com",
            "affiliation": "Y",
            "endpointDescription": "Sibley",
            "affiliationName": "Children's Healthcare of Atlanta",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PHI",
            "address_1": "738 Old Norcross Rd",
            "city": "Lawrenceville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300464462",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.