Individual provider Active NPI

James E Rose, P.A.-C

  • Physician Assistant
  • Locust Grove, GA
National Provider Identifier
1083866743
Registry record updated May 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
003570 Issued in GA
Practice address
4861 Bill Gardner Pkwy
Ste 100
Locust Grove, GA 30248-3644
Phone
(770) 626-5740
Fax
(770) 626-5750
NPI assigned
Oct 14, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 003570 GA Primary

Addresses

Primary practice location

4861 Bill Gardner Pkwy
Ste 100
Locust Grove, GA 30248-3644

Mailing address

4861 Bill Gardner Pkwy
Ste 100
Locust Grove, GA 30248-3644
Phone (770) 626-5740

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
I20081110000622 GA Practitioner - Physician Assistant 0042379703 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstreet of Georgia PCGroup PAC ID 7517126279, 425 clinicians

Practice addresses (Care Compare)

2292 Peachtree Rd
Atlanta, GA 30309-1147
Phone (404) 382-9941

7990 Wells St
Suite 120
Senoia, GA 30276-2024
Phone (678) 535-0220

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
003570GAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Parkway Anesthesia Consultants, PC Past Accepting new patients
Emerginet, LLC PastSince Jul 1, 2001 Accepting new patients

Organizations & group practices 3

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": "1223942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432166400000",
    "number": "1083866743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4861 BILL GARDNER PKWY",
            "address_2": "STE 100",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302483644",
            "telephone_number": "770-626-5740",
            "fax_number": "770-626-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4861 BILL GARDNER PKWY",
            "address_2": "STE 100",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302483644",
            "telephone_number": "770-626-5740",
            "fax_number": "770-626-5750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "JAMES",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-14",
        "last_updated": "2015-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "003570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Locust Grove, GA

Sources for this page

Verify at the official NPI Registry.