Peachstate Prosthetics and Orthotics, Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

PEACHSTATE PROSTHETICS AND ORTHOTICS, INC

Practice address

178 Bracketts Way Ste 3
Blairsville, GA 30512-2984

Phone

(706) 400-5750

Fax

(706) 400-5751

NPI assigned

Jun 10, 2005

Organization subpart

No

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

Authorized official

Name

Susan G Semmes, LCPONPI 1528308319

Title

President

Phone

(706) 400-5750

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan Grogan Semmes, CPO/LPO

  • Prosthetist
  • Valdosta, GA
  • NPI 1528308319
  NPD (past) Authorized official

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569196800000",
    "number": "1003810748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 BRACKETTS WAY STE 3",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "305122984",
            "telephone_number": "706-400-5750",
            "fax_number": "706-400-5751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "178 BRACKETTS WAY STE 3",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "305122984",
            "telephone_number": "706-400-5750",
            "fax_number": "706-400-5751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHSTATE PROSTHETICS AND ORTHOTICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-10",
        "last_updated": "2019-09-23",
        "status": "A",
        "authorized_official_last_name": "SEMMES",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-400-5750",
        "authorized_official_credential": "LCPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000690852A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE SALES TAX ID",
            "identifier": "20010497912",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1003810748",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPOSITE MEDICAL BOARD",
            "identifier": "LPO#000004",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rolando Ors III, DPT
• Christine Owen
• Parr Family Ventures, LLC
• Sandra Elizabeth Stepp Patton, M.D.
• Shawn Douglas Payne, CADC II
• Cassidy Starling Peacock, O.D.
• Adriana Peck
• Jack Wayne Pennington, M.D.
• Johnny C Pitts, PA-C
• Sandra Danette Poppell, DO

• Prosthetic/Orthotic Supplier in Blairsville, GA
• Providers in Blairsville, GA by specialty
• Prosthetic/Orthotic Supplier in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.