NPIMap

Organization Active NPI

Northwest Georgia Medical Clinic, P.C.

  • Obstetrics & Gynecology Physician
  • Rome, GA
National Provider Identifier
1053462325
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
NORTHWEST GEORGIA MEDICAL CLINIC, P.C.
Practice address
15 Riverbend Dr SW
Ste 200
Rome, GA 30161-6065
Phone
(706) 378-5651
Fax
(706) 378-8267
NPI assigned
Jan 15, 2007
Last updated
Apr 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

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

Authorized official

Name
Mrs. Angie Smith
Title
Financial Coord
Phone
(706) 378-5651

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X
Obstetrics & Gynecology Physician 207V00000X Primary

Addresses

Primary practice location

15 Riverbend Dr SW
Ste 200
Rome, GA 30161-6065

Mailing address

15 Riverbend Dr SW
Ste 200
Rome, GA 30161-6065
Phone (706) 378-5651

Other identifiers 1

IdentifierTypeStateIssuer
CL0326OtherGARAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040329001145 GA Part B Supplier - Clinic/Group Practice 7315839743 Receives reassigned benefits from 13 practitioners
Practice locations: Rome, GA

National Provider Directory

National Provider Directory

Locations

1013 N 5th Ave NE
Ste 2
Rome, GA 30165
Phone (706) 291-0884

15 Riverbend Dr SW
Rome, GA 30161
Phone (706) 291-0084

15 Riverbend Dr SW
Ste 200
Rome, GA 30161
Phone (706) 291-0884

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1053462325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 RIVERBEND DR SW",
            "address_2": "STE 200",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301616065",
            "telephone_number": "706-378-5651",
            "fax_number": "706-378-8267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 RIVERBEND DR SW",
            "address_2": "STE 200",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301616065",
            "telephone_number": "706-378-5651",
            "fax_number": "706-378-8267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST GEORGIA MEDICAL CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-15",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "FINANCIAL COORD",
        "authorized_official_telephone_number": "706-378-5651",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CL0326",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rome, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; 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.