Georgia D Eltabbakh, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0550030657 Issued in VT

Practice address

1060 Hinesburg Rd
Suite 301
South Burlington, VT 05403-7612

Phone

(802) 859-9500

Fax

(802) 859-9944

NPI assigned

Sep 22, 2005

Last updated

Jun 28, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VT

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

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372377600000",
    "number": "1871589150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 HINESBURG RD",
            "address_2": "SUITE 301",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037612",
            "telephone_number": "802-859-9500",
            "fax_number": "802-859-9944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 HINESBURG RD",
            "address_2": "SUITE 301",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037612",
            "telephone_number": "802-859-9500",
            "fax_number": "802-859-9944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELTABBAKH",
        "first_name": "GEORGIA",
        "middle_name": "D",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-22",
        "last_updated": "2013-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "010999",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VT",
            "license": "0550030657",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "VT",
            "license": "0550030657",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90000398",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elcm Manor South Management LLC (Pillsbury Manor South)
• Elevate Health Chiropractic LLC
• Katherine C Elmer, NBC-HWC
• Jennifer May Elsinger, OTR/L, CHT
• Gamal H Eltabbakh, M.D.
• Elvira Zulkic, MSW. LLC
• Jill Lorraine Entis, LICSW
• Erik Willis, Ma, LLC
• Lisa Martin Eriksson, O.D.
• Reimy Evangelista de Leon, DDS

• Medical Physician Assistant in South Burlington, VT
• Providers in South Burlington, VT by specialty
• Medical Physician Assistant in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.