Individual provider Active NPI

Yeohan Song, MD

  • Rheumatology Physician
  • Duluth, GA
National Provider Identifier
1003279571
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
94419 Issued in GA
Practice address
3500 McClure Bridge Rd
Duluth, GA 30096-3131
Phone
(770) 476-3636
Fax
(770) 476-5845
NPI assigned
Apr 1, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X 94419 GA Primary

Addresses

Primary practice location

3500 McClure Bridge Rd
Duluth, GA 30096-3131

Mailing address

3500 McClure Bridge Rd
Duluth, GA 30096-3131
Phone (770) 476-3636

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230626001728 GA Practitioner - Rheumatology 7911297387 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Rheumatology
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Georgia Diagnostic Associates and Clinic, LLCGroup PAC ID 1951655737, 81 clinicians

Practice addresses (Care Compare)

3500 McClure Bridge Rd
Duluth, GA 30096-3131
Phone (770) 476-3636

Hospital & facility affiliations

  • Northside Hospital Gwinnett Hospital, Lawrenceville, GA, CCN 110087
  • Northside Hospital Duluth Hospital, Duluth, GA, CCN 110252

Merit-based Incentive Payment System (MIPS)

Final score
78.26 of 100Reported as group
Quality
71.9
Promoting interoperability
75
Improvement activities
40
Cost
76.47

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
94419GAMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Georgia Diagnostic Associates and Clinic, LLC CurrentSince Aug 1, 2023 Accepting new patients
Northeast Georgia Diagnostic Clinic LLC Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

3500 McClure Bridge Rd
Duluth, GA 30096
Phone (770) 476-3636

1250 Jesse Jewell Pkwy SE
Ste 400
Gainesville, GA 30501
Phone (470) 228-7507

1240 Jesse Jewell Pkwy SE
Ste 500
Gainesville, GA 30501

Networks

  • devoted network organization-25ba88d3-d0a6-4213-84f1-eef6f2b59f68
  • TN PPO C-SNP
  • devoted network organization-84bf27aa-506a-49c4-8818-702cf5e8efb3
  • devoted network organization-14bfd35d-d818-4696-813b-340339e464ef
  • FL HMO D-SNP
  • AL HMO D-SNP
  • TN PPO
  • devoted network organization-d5084670-562f-408b-b100-22a1a4ef4d82
  • FL HMO C-SNP
  • FL HMO
  • AL HMO
  • devoted network organization-0f7f8d4f-1035-4992-8c02-dc86d12e700e

Interoperability endpoints

  • Direct secure messaging: yeohansong@negaidx.allscriptsdirect.net

Organizations & group practices 3

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 2

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": "1459468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1003279571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 MCCLURE BRIDGE RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300963131",
            "telephone_number": "770-476-3636",
            "fax_number": "770-476-5845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 MCCLURE BRIDGE RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300963131",
            "telephone_number": "770-476-3636",
            "fax_number": "770-476-5845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "YEOHAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-01",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "GA",
            "license": "94419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, GA

Sources for this page

Verify at the official NPI Registry.