NPIMap

Organization Active NPI

North Fulton Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Roswell, GA
National Provider Identifier
1053456954
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
NORTH FULTON EMERGENCY PHYSICIANS, LLC
Practice address
3000 Hospital Blvd
Roswell, GA 30076-4915
Phone
(770) 751-2500
NPI assigned
Feb 20, 2007
Last updated
Feb 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Authorized official

Name
Kim H Larsen
Title
Director of Credentialing
Phone
(770) 874-5400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

3000 Hospital Blvd
Roswell, GA 30076-4915

Mailing address

PO Box 22083
Belfast, ME 04915-4117
Phone (770) 874-5400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071004000272 GA Part B Supplier - Clinic/Group Practice 6800981986 Receives reassigned benefits from 82 practitioners
Practice locations: Roswell, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 100

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 100

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1053456954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22083",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154117",
            "telephone_number": "770-874-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 HOSPITAL BLVD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764915",
            "telephone_number": "770-751-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH FULTON EMERGENCY PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "770-874-5400"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.