NPIMap

Individual provider Active NPI

Guillermo A Pena, MD

  • Internal Medicine Physician
  • Blue Ridge, GA
National Provider Identifier
1013978162
Registry record updated Nov 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
059493 Issued in GA
Practice address
165 Blue Ridge Overlook
Blue Ridge, GA 30513-4431
Phone
(706) 946-4647
Fax
(706) 374-5006
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 46222 FL
Internal Medicine Physician 207R00000X 059493 GA Primary

Addresses

Primary practice location

165 Blue Ridge Overlook
Blue Ridge, GA 30513-4431

Mailing address

165 Blue Ridge Overlook
Blue Ridge, GA 30513-4431
Phone (706) 946-5608

Other identifiers 2

IdentifierTypeStateIssuer
297695058AMedicaidGA
040614700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140218001375 GA Practitioner - Internal Medicine 4486663739 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Georgia Mountains Health Services, Inc.Group PAC ID 7719974831, 21 clinicians

Practice addresses (Care Compare)

1008 N 3Rd Ave
Chatsworth, GA 30705-2118
Phone (706) 517-2273

165 Blue Ridge Overlook
Blue Ridge, GA 30513-4431
Phone (706) 946-4647

Hospital & facility affiliations

  • Amedisys Northwest Home Health Home health agency, Jasper, GA, CCN 117064
  • Tugaloo Home Health Agency, an Amedisy Company Home health agency, Gainesville, GA, CCN 117305
  • Pruitthealth at Home - Gainesville Home health agency, Gainesville, GA, CCN 117129
  • Northeast Georgia Medical Center, Inc Hospital, Gainesville, GA, CCN 110029
  • Union General Hospital Hospital, Blairsville, GA, CCN 110051
  • Blue Ridge Medical Center Hospital, Blue Ridge, GA, CCN 111338
  • Piedmont Mountainside Hospital Inc Hospital, Jasper, GA, CCN 110225
  • Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
46222FLMDInternal Medicine Physician
059493GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Mountains Health Services, Inc. Current Accepting new patients
Georgia Mountains Health Services, Inc. CurrentSince Oct 25, 2013 Accepting new patients
Georgia Mountains Health Services, Inc. CurrentSince Oct 25, 2013 Accepting new patients
Georgia Mountains Health Services, Inc. Past Accepting new patients
Georgia Mountains Health Services, Inc. Past Accepting new patients

Locations

165 Blue Ridge Overlook
Blue Ridge, GA 30513
Phone (706) 946-4647

1008 N 3rd Ave
Chatsworth, GA 30705
Phone (706) 517-2273

134 Ansley Dr
Ste 700
Dahlonega, GA 30533
Phone (706) 701-5001

Interoperability endpoints

  • Direct secure messaging: guilermo.pena@gadirect.net
  • Direct secure messaging: guillermo.pena.1@20104.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/20104/brand/1/csg/1/fhir/r4

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.

Hospital & facility affiliations 10

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": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1013978162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 BLUE RIDGE OVERLOOK",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305134431",
            "telephone_number": "706-946-5608",
            "fax_number": "706-374-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 BLUE RIDGE OVERLOOK",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305134431",
            "telephone_number": "706-946-4647",
            "fax_number": "706-374-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "GUILLERMO",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "46222",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "059493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "297695058A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040614700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blue Ridge, GA

Sources for this page

Verify at the official NPI Registry.