Active NPI
Erica Maria Pena, PA-C
- Physician Assistant
- Norcross, GA
National Provider Identifier
1013570118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 38817
- Practice address
- 6131 S Norcross Tucker Rd Ste 6
Norcross, GA 30093-5536 - Phone
- (678) 205-1959
- NPI assigned
- Apr 16, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 38817 | GA | Primary |
Addresses
Primary practice location
6131 S Norcross Tucker Rd Ste 6
Norcross, GA 30093-5536
Mailing address
679 Roxboro CT
Lawrenceville, GA 30044-5663
Phone (678) 353-5640
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38817 | GA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Georgia Em-I Medical Services, LLC | Physician Assistant | Current | Accepting new patients |
| Lavender Inpatient Services LLC | Past | Accepting new patients | |
| Mount Lassen Emergency Physicians LLC | Past | Accepting new patients |
Locations
5126 Hospital Dr NE
Covington, GA 30014
Phone (770) 385-4340
1700 Medical Way
Snellville, GA 30078
Phone (770) 978-4229
Interoperability endpoints
- erica.pena.1@31578.direct.athenahealth.com
Organizations & group practices 5
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.
-
- Family Medicine Physician
- Norcross, GA
- NPI 1770097719
-
- Nurse Practitioner
- Bremen, GA
- NPI 1851569560
-
- Nurse Practitioner
- Covington, GA
- NPI 1255213005
Physician Assistant
-
- Internal Medicine Physician
- Cartersville, GA
- NPI 1902215767
-
- Emergency Medicine Physician
- Cartersville, GA
- NPI 1730598590
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555372800000",
"number": "1013570118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "679 ROXBORO CT",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300445663",
"telephone_number": "678-353-5640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6131 S NORCROSS TUCKER RD STE 6",
"city": "NORCROSS",
"state": "GA",
"postal_code": "300935536",
"telephone_number": "678-205-1959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENA",
"first_name": "ERICA",
"middle_name": "MARIA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-16",
"last_updated": "2019-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "38817",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norcross, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2019; 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.