NPIMap

Organization Active NPI

Idoc Virtual Neuro Critical Care LLC

  • Specialist
  • Stockbridge, GA
National Provider Identifier
1053926154
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
IDOC VIRTUAL NEURO CRITICAL CARE LLC
Practice address
1133 Eagles Landing Pkwy
Stockbridge, GA 30281-5085
Phone
(713) 913-1422
NPI assigned
Sep 15, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Authorized official

Name
Evette Lewis
Title
Practice Manager
Phone
(503) 421-5124

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary
Critical Care Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LC0200X
Critical Care Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0200X
Critical Care Medicine Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LC0200X

Addresses

Primary practice location

1133 Eagles Landing Pkwy
Stockbridge, GA 30281-5085

Mailing address

4635 Southwest Fwy Ste 525
Houston, TX 77027-7157
Phone (713) 234-4431

Other practice location 1

159 E Wesley Rd NE
Atlanta, GA 30305-3707
Phone (832) 982-7788

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210511002519 GA Part B Supplier - Clinic/Group Practice 9133538796 Receives reassigned benefits from 12 practitioners
Practice locations: Marietta, GA
O20250517000014 GA Part B Supplier - Clinic/Group Practice 9133538796 Practice locations: Marietta, GA

National Provider Directory

National Provider Directory

Locations

1668 Mulkey Rd
Ste 116
Austell, GA 30106

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724198400000",
    "number": "1053926154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4635 SOUTHWEST FWY STE 525",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770277157",
            "telephone_number": "713-234-4431",
            "fax_number": "877-712-5707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 EAGLES LANDING PKWY",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815085",
            "telephone_number": "713-913-1422"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "159 E Wesley Rd NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303053707",
            "country_code": "US",
            "telephone_number": "832-982-7788",
            "fax_number": "303-648-4534",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IDOC VIRTUAL NEURO CRITICAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-15",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "EVETTE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "503-421-5124"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 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.