NPIMap

Organization Active NPI

Post Acute Care Leaders LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Carrollton, GA
National Provider Identifier
1033689336
Registry record updated Jun 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
POST ACUTE CARE LEADERS LLC
Practice address
156 Pine Knoll Dr
Carrollton, GA 30117-2451
Phone
(678) 593-3332
Fax
(678) 868-1584
NPI assigned
Nov 29, 2018
Last updated
Jun 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2022

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

Authorized official

Name
Tyler Justiss
Title
Controller
Phone
(678) 593-3332

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X NU Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X NU
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

156 Pine Knoll Dr
Carrollton, GA 30117-2451

Mailing address

925 N Point Pkwy Ste 425
Alpharetta, GA 30005-5200
Phone (678) 593-3332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190123000710 GA Part B Supplier - Clinic/Group Practice 4082951546 Receives reassigned benefits from 22 practitioners
Practice locations: Alpharetta, GA; Breman, GA; Carrollton, GA; Elijay, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1543449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1033689336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 N POINT PKWY STE 425",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300055200",
            "telephone_number": "678-593-3332",
            "fax_number": "678-868-1584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 PINE KNOLL DR",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301172451",
            "telephone_number": "678-593-3332",
            "fax_number": "678-868-1584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POST ACUTE CARE LEADERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-29",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A",
        "authorized_official_last_name": "JUSTISS",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "678-593-3332"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.