Individual provider Active NPI

Nancy A Demester, PA

  • Medical Physician Assistant
  • Marietta, GA
National Provider Identifier
1851343982
Registry record updated May 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
003601 Issued in GA
Practice address
790 Church St NE
Ste 400
Marietta, GA 30060-7282
Phone
(770) 952-8899
NPI assigned
May 17, 2006
Last updated
May 9, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 003601 GA Primary

Addresses

Primary practice location

790 Church St NE
Ste 400
Marietta, GA 30060-7282

Mailing address

PO Box 3157
Indianapolis, IN 46206-3157
Phone (770) 952-8899

Other identifiers 1

IdentifierTypeStateIssuer
100002663MedicaidGA

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220112000392 GA Practitioner - Physician Assistant 6103873559 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Emory University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

20 Glenlake Pkwy
Atlanta, GA 30328-3473
Phone (770) 677-6043

3495 Piedmont Rd NE
Atlanta, GA 30305-1729
Phone (404) 364-7206

750 Townpark LN NW
Kennesaw, GA 30144-5579
Phone (770) 514-5405

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
003601GAMDMedical Physician Assistant
3601GAMDCertified Registered Nurse Anesthetist

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.

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462752000000",
    "number": "1851343982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3157",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462063157",
            "telephone_number": "770-952-8899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 CHURCH ST NE",
            "address_2": "STE 400",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607282",
            "telephone_number": "770-952-8899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMESTER",
        "first_name": "NANCY",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2016-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "003601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002663",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.