NPIMap

Kaiser Foundation Health Plan of Georgia, Inc.

Organization Active NPI Managed Care Organization Pharmacy · Atlanta, GA

NPI 1093757809 · NPPES record last updated Aug 4, 2021

Key facts

NPI
1093757809
Entity type
Organization (NPI type 2)
Primary specialty
Managed Care Organization Pharmacy 3336M0003X
License
PHRE007915 (GA)
Legal business name
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Practice address
20 Glenlake Pkwy NE
Atlanta, GA 30328-3473
Phone
(770) 677-6000
Fax
(770) 677-7306
NPI assigned
Jun 13, 2006
Organization subpart
No

Authorized official

Name
Ms. Diane Sanders
Title
Phcy Compliance MGR
Phone
(770) 712-5654

Corporate family (same tax ID) 17

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Kaiser Foundation Health (67 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Managed Care Organization Pharmacy 3336M0003X PHRE007915 GA Yes

Addresses

Primary practice location

20 Glenlake Pkwy NE
Atlanta, GA 30328-3473

Mailing address

20 Glenlake Pkwy NE
Atlanta, GA 30328-3473
Phone (770) 677-6000

Other identifiers

IdentifierTypeStateIssuer
1136971OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names

  • KAISER PERMANENTE GLENLAKE Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 4, 2021.

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1093757809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 GLENLAKE PKWY NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303283473",
            "telephone_number": "770-677-6000",
            "fax_number": "770-677-7306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 GLENLAKE PKWY NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303283473",
            "telephone_number": "770-677-6000",
            "fax_number": "770-677-7306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "PHCY COMPLIANCE MGR",
        "authorized_official_telephone_number": "770-712-5654",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": "GA",
            "license": "PHRE007915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1136971",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "20 Glenlake Pkwy NE",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303283473",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "KAISER PERMANENTE GLENLAKE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KAISER PERMANENTE GLENLAKE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

All providers in Atlanta, GA · Managed Care Organization Pharmacy in Georgia

Sources for this page

Verify at the official NPI Registry.