Individual provider Active NPI

Romulo Laureta Parungao, M.D.

  • Emergency Medicine Physician
  • Fort Defiance, AZ
National Provider Identifier
1003963265
Registry record updated Oct 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
16121 Issued in GA
Practice address
Corner of Route N12 and N7
Fort Defiance, AZ 86504
Phone
(928) 729-8600
NPI assigned
Jan 3, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 16121 GA Primary

Addresses

Primary practice location

Corner of Route N12 and N7
Fort Defiance, AZ 86504

Mailing address

2073 Honey Creek Rd SW
Conyers, GA 30094-3423
Phone (678) 852-6004

Other identifiers 1

IdentifierTypeStateIssuer
00085566R-0MedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary'S Good Samaritan Hospital, Inc. Current Accepting new patients
Acs Primary Care Physicians - Southeast PC Emergency Medicine Past Accepting new patients
Athens-Clarke Emergency Specialists Emergency Medicine Past Accepting new patients
Fannin Ed Physicians LLC Emergency Medicine Past Accepting new patients
Inphynet Primary Care Physicians Southeast PC Emergency Medicine Past Accepting new patients
Prime Immediate Care LLC PastSince Oct 1, 2007 Accepting new patients

Locations

1201 Siloam Rd
Greensboro, GA 30642
Phone (706) 453-7331

5401 Lake Oconee Pkwy
Greensboro, GA 30642
Phone (706) 453-7331

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571616000000",
    "number": "1003963265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2073 HONEY CREEK RD SW",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300943423",
            "telephone_number": "678-852-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CORNER OF ROUTE N12 AND N7",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "86504",
            "telephone_number": "928-729-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARUNGAO",
        "first_name": "ROMULO",
        "middle_name": "LAURETA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2019-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "16121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00085566R-0",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Defiance, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.