Gary M Dutka, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

004291 Issued in GA

Practice address

2000 Dan Proctor Dr
Saint Marys, GA 31558-3810

Phone

(912) 466-7000

Fax

(919) 477-5470

NPI assigned

Feb 20, 2006

Last updated

Aug 6, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

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

Specialty

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ergent Med PrimeGroup PAC ID 8820362189, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Ergent Med Prime

  • Primary Care Clinic/Center
  • Brunswick, GA
  • NPI 1811345390
  Medicare reassignment Care Compare group
• Emergency Physicians Inc

  dba Emergency Resource Group

  • Emergency Medicine Physician
  • Brunswick, GA
  • NPI 1477001972
  Medicare reassignment NPD
• Georgia Emergency Associates

  • Emergency Medicine Physician
  • Rincon, GA
  • NPI 1528098290
  Medicare reassignment
• Advanced Pediatric Specialists LLC

  • Pediatrics Physician
  • Savannah, GA
  • NPI 1073046397
  NPD (past)
• Ergent Med-1 LLC

  dba ERgent Med-1

  • Primary Care Clinic/Center
  • Brunswick, GA
  • NPI 1356778211
  NPD (past)

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

{
    "created_epoch": "1140393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217980800000",
    "number": "1902871445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15385",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277040385",
            "telephone_number": "919-477-5152",
            "fax_number": "919-477-5474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 DAN PROCTOR DR",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315583810",
            "telephone_number": "912-466-7000",
            "fax_number": "919-477-5470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUTKA",
        "first_name": "GARY",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-20",
        "last_updated": "2008-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "004291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256737965C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256737965D",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01157750",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256737965A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donald Scott Dills, LDO
• Daniel A. Dino, M.D.
• Dr. Victoria Warner-White
• Neil Edwin Duchac II, PH.D.
• Marcelle Dunning
• Lesly Kay Duvall, FNP
• Dva Healthcare Renal Care Inc (St. Marys Dialysis)
• Jessica Dyals, MSN, APRN, FNP-C
• Edward J Smith DC PC
• Mary Elizabeth Edwards

• Medical Physician Assistant in Saint Marys, GA
• Providers in Saint Marys, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2008; 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.