Active NPI
Qiuping A Pan
- Family Medicine Physician
- Dublin, GA
National Provider Identifier
1003080524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 65409
- Practice address
- 1826 Veteran Blvd
Dublin, GA 31021 - Phone
- (478) 272-1210
- NPI assigned
- Apr 15, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 65409 | GA | Primary |
Addresses
Primary practice location
1826 Veteran Blvd
Dublin, GA 31021
Mailing address
3245 Flowers Rd S Apt V
Atlanta, GA 30341-5680
Phone (770) 457-6043
Medicare participation
Medicare enrollment files- 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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160302001703 | GA | Order and Referring Only - Family Practice | 3779889688 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65409 | GA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329696000000",
"number": "1003080524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3245 FLOWERS RD S APT V",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303415680",
"telephone_number": "770-457-6043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1826 VETERAN BLVD",
"city": "DUBLIN",
"state": "GA",
"postal_code": "31021",
"telephone_number": "478-272-1210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAN",
"first_name": "QIUPING",
"middle_name": "A",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-15",
"last_updated": "2012-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "65409",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dublin, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.