Individual provider Active NPI

Lisa Kirkland, MD

  • Emergency Medical Services (Emergency Medicine) Physician
  • Macon, GA
National Provider Identifier
1093818312
Registry record updated Feb 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
46314 Issued in GA
Practice address
350 Hospital Dr
Macon, GA 31217-3838
Phone
(770) 994-9326
Fax
(770) 994-4747
NPI assigned
Sep 6, 2006
Last updated
Feb 12, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 46314 GA Primary

Addresses

Primary practice location

350 Hospital Dr
Macon, GA 31217-3838

Mailing address

235 Peachtree St NE
North Tower, Suite 2100
Atlanta, GA 30303-1401
Phone (770) 994-9326

Other identifiers 2

IdentifierTypeStateIssuer
413046400MedicaidMD
413496600MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080107000316 MD Practitioner - Emergency Medicine 1850339219 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
46314GAMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mep Observation Services LLC CurrentSince Apr 28, 2020 Accepting new patients
Mep Health, LLC CurrentSince Jul 1, 2017 Accepting new patients
Mep Observation Services LLC CurrentSince Apr 28, 2020 Accepting new patients
Summit Macon LLC Emergency Medical Services Past Accepting new patients
Champion Emergency Physicians LLC Past Accepting new patients

Locations

2000 W Baltimore St
Baltimore, MD 21223
Phone (410) 362-3075

2401 W Belvedere Ave
Baltimore, MD 21215

12500 Willowbrook Rd
Cumberland, MD 21502
Phone (240) 964-1255

5401 Old Court Rd
Randallstown, MD 21133
Phone (301) 337-2727

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202774400000",
    "number": "1093818312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 PEACHTREE ST NE",
            "address_2": "NORTH TOWER, SUITE 2100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303031401",
            "telephone_number": "770-994-9326",
            "fax_number": "770-994-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 HOSPITAL DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312173838",
            "telephone_number": "770-994-9326",
            "fax_number": "770-994-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRKLAND",
        "first_name": "LISA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-06",
        "last_updated": "2008-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "GA",
            "license": "46314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "413046400",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "413496600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.