Individual provider Active NPI

Nicola Mario Zetola

  • Critical Care Medicine (Internal Medicine) Physician
  • Augusta, GA
National Provider Identifier
1952803157
Registry record updated Nov 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
85992 Issued in GA
Practice address
1120 15TH Street
Augusta, GA 30912-0004
Phone
(706) 721-8623
Fax
(706) 721-1459
NPI assigned
Mar 3, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 00000 PA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X D88446 MD
Infectious Disease Physician 207RI0200X 00000 PA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 85992 GA Primary

Addresses

Primary practice location

1120 15TH Street
Augusta, GA 30912-0004

Mailing address

110 S Paca St
Baltimore, MD 21201-1642
Phone (410) 328-4409

Other practice location 1

12500 Willowbrook Rd
Cumberland, MD 21502-6393
Phone (240) 964-8750

Other practice location 2

110 S Paca St
Baltimore, MD 21201-1642
Phone (410) 328-4409

Other practice location 3

12502 Willowbrook Rd Ste 280
Cumberland, MD 21502-6494
Phone (240) 964-8750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210324002187 GA Practitioner - Internal Medicine 9537406780 Reassigns benefits to 2 organizations
I20230329001502 IL Practitioner - Critical Care (Intensivists) 9537406780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

1120 15TH St
Augusta, GA 30912-0004
Phone (706) 721-8623

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

989 Saint Sebastian Way
Augusta, GA 30912-0004
Phone (706) 721-2171

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00000PAMDDentist
85992GAMDCritical Care Medicine (Internal Medicine) Physician
D88446MDMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Apr 1, 2024 Accepting new patients
Au Medical Associates Inc CurrentSince Mar 8, 2021 Accepting new patients
Critical Care Physicians of Illinois LLC Critical Care Medicine CurrentSince Mar 1, 2023 Accepting new patients
Au Medical Associates Inc CurrentSince Mar 8, 2021 Accepting new patients
Upmc Western Maryland Health Services, LLC Internal Medicine Past Accepting new patients
Upmc Western Maryland Corporation Past Accepting new patients
Au Medical Center, Inc Past Accepting new patients

Locations

1120 15th St
Augusta, GA 30912
Phone (706) 721-3873

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

800 W Central Rd
Arlington Hts, IL 60005
Phone (847) 618-6150

1325 N Highland Ave
Aurora, IL 60506
Phone (630) 801-2756

20201 Crawford Ave
Olympia Flds, IL 60461
Phone (708) 503-3857

120 Brentwood Commons Way
Ste 510
Brentwood, TN 37027
Phone (253) 682-6040

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1520035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1952803157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S PACA ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011642",
            "telephone_number": "410-328-4409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 15TH STREET",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120004",
            "telephone_number": "706-721-8623",
            "fax_number": "706-721-1459"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12500 Willowbrook Rd",
            "address_purpose": "LOCATION",
            "city": "Cumberland",
            "state": "MD",
            "postal_code": "215026393",
            "country_code": "US",
            "telephone_number": "240-964-8750",
            "fax_number": "240-964-8699",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "110 S Paca St",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212011642",
            "country_code": "US",
            "telephone_number": "410-328-4409",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12502 Willowbrook Rd Ste 280",
            "address_purpose": "LOCATION",
            "city": "Cumberland",
            "state": "MD",
            "postal_code": "215026494",
            "country_code": "US",
            "telephone_number": "240-964-8750",
            "fax_number": "240-964-8699",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZETOLA",
        "first_name": "NICOLA",
        "middle_name": "MARIO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-03",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "00000",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MD",
            "license": "D88446",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "PA",
            "license": "00000",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "GA",
            "license": "85992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.