Individual provider Active NPI

Jasmine Rose Ling Duan

  • Family Nurse Practitioner
  • Suwanee, GA
National Provider Identifier
1023767308
Registry record updated Dec 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN290908 Issued in GA
Practice address
4235 Johns Creek Pkwy Ste a
Suwanee, GA 30024-6038
Phone
(678) 402-9550
Fax
(675) 802-5765
NPI assigned
Mar 22, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN290908 GA Primary

Addresses

Primary practice location

4235 Johns Creek Pkwy Ste a
Suwanee, GA 30024-6038

Mailing address

2805 Hamilton Mill Rd
Buford, GA 30519-4110

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220923001640 GA Practitioner - Nurse Practitioner 7517342751 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Mercer University School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeast Medical Group, P.C.Group PAC ID 3577559673, 139 clinicians

Practice addresses (Care Compare)

4235 Johns Creek Pkwy
Suite a
Suwanee, GA 30024-6038
Phone (770) 442-1911

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Medical Group, P.C. CurrentSince Sep 12, 2022 Accepting new patients
Priority Primary Care Past Accepting new patients

Locations

3905 Brookside Pkwy
Ste 300
Alpharetta, GA 30022
Phone (770) 442-9111

1255 Friendship Rd
Ste 130
Braselton, GA 30517
Phone (678) 341-6350

4700 Nelson Brogdon Blvd
Ste 250
Buford, GA 30518
Phone (678) 341-6380

1800 Northside Forsyth Dr
Ste 450
Cumming, GA 30041
Phone (678) 947-6440

3790 Pleasant Hill Rd
Ste 170
Duluth, GA 30096
Phone (770) 360-1020

771 Old Norcross Rd
Ste 225
Lawrenceville, GA 30046
Phone (678) 802-4045

1150 Hammond Dr
Ste 310
Sandy Springs, GA 30328
Phone (678) 802-5780

4235 Johns Creek Pkwy
Ste A
Suwanee, GA 30024
Phone (678) 402-9550

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DIJIBA

Organizations & group practices 2

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": "1647907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1023767308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 HAMILTON MILL RD",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305194110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4235 JOHNS CREEK PKWY STE A",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246038",
            "telephone_number": "678-402-9550",
            "fax_number": "675-802-5765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LING DUAN",
        "first_name": "JASMINE",
        "middle_name": "ROSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-22",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN290908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suwanee, GA

Sources for this page

Verify at the official NPI Registry.