NPIMap

Individual provider Active NPI

Niti Bhalla Carlson, MD

  • Gynecology Physician
  • Evans, GA
National Provider Identifier
1972599363
Registry record updated May 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
045052 Issued in GA
Practice address
465 N Belair Rd Ste 2E
Evans, GA 30809-3190
Phone
(706) 855-5510
Fax
(706) 855-7254
NPI assigned
Sep 21, 2005
Last updated
May 21, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 045052 GA Primary

Addresses

Primary practice location

465 N Belair Rd Ste 2E
Evans, GA 30809-3190

Mailing address

3829 Honors Way
Martinez, GA 30907-9147
Phone (706) 855-5929

Other identifiers 2

IdentifierTypeStateIssuer
G45052OtherSCMEDICAID
00914955BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091119000517 GA Practitioner - Obstetrics/Gynecology 6608915293 Reassigns benefits to 1 organization
Practice locations: Evans, GA

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Medical College of Georgia School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Niti Bhalla Carlson MD PCGroup PAC ID 9436396876, 2 clinicians

Practice addresses (Care Compare)

465 N Belair Rd
Evans, GA 30809-3190
Phone (706) 855-5510

465 N Belair Rd
Suite 2 E
Evans, GA 30809-3188

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
045052GAMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Niti Bhalla Carlson MD PC Gynecology CurrentSince Mar 1, 2013 Accepting new patients
Augusta Physician Services LLC Gynecology Past Accepting new patients

Locations

2258 Wrightsboro Rd
Ste 200
Augusta, GA 30904
Phone (706) 396-0112

465 N Belair Rd
Ste 2E
Evans, GA 30809
Phone (706) 855-5510

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/6517/brand/1/csg/1/fhir/r4
  • Direct secure messaging: niti.carlson.1@6517.direct.athenahealth.com

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.

Hospital & facility affiliations 7

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": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590019200000",
    "number": "1972599363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3829 HONORS WAY",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309079147",
            "telephone_number": "706-855-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 N BELAIR RD STE 2E",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093190",
            "telephone_number": "706-855-5510",
            "fax_number": "706-855-7254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "NITI",
        "middle_name": "BHALLA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-21",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "GA",
            "license": "045052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "G45052",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00914955B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evans, GA

Sources for this page

Verify at the official NPI Registry.