Nilaphone Nok Homsombath

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

007194 Issued in GA

Practice address

1350 Walton Way
Emergency Department
Augusta, GA 30901-2612

Phone

(706) 774-8249

NPI assigned

Jul 13, 2010

Last updated

May 29, 2015By 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 2

Addresses

Other names 1

• Nilaphone Nok Kettavong Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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.

• Augusta Physicians Group, LLC

  • Emergency Medicine Physician
  • Augusta, GA
  • NPI 1518169168
  NPD (past)

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

{
    "created_epoch": "1278979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432857600000",
    "number": "1871805309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 FROG HOLLOW CT",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308094904",
            "telephone_number": "706-832-5046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 WALTON WAY",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309012612",
            "telephone_number": "706-774-8249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOMSOMBATH",
        "first_name": "NILAPHONE",
        "middle_name": "NOK",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-13",
        "last_updated": "2015-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "007194",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "1787",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NILAPHONE",
            "last_name": "KETTAVONG",
            "middle_name": "NOK",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Homestead Hospice of Augusta, LLC (Traditions Health)
• Homestead Hospice of Augusta, LLC (Traditions Health)
• Christopher Homeyer, M.D.
• Kelly Homlar, MD
• Bounthavy Homsombath, MD
• Shamika Lynette Honeyblue, O.D.
• Chaohui Hong
• Rebecca Elizabeth Hood I
• Steven John Hood, DMD
• Laquanis Shena Hooker, DDS

• Physician Assistant in Augusta, GA
• Providers in Augusta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.