NPIMap

Individual provider Active NPI

Shomari Andre Ruffin, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Carrollton, GA
National Provider Identifier
1114185840
Registry record updated Oct 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
72107 Issued in GA
Practice address
150 Clinic Ave
Suite 101
Carrollton, GA 30117-4401
Phone
(770) 834-0873
Fax
(770) 834-6118
NPI assigned
May 29, 2008
Last updated
Oct 30, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 72107 GA Primary

Addresses

Primary practice location

150 Clinic Ave
Suite 101
Carrollton, GA 30117-4401

Mailing address

150 Clinic Ave
Suite 101
Carrollton, GA 30117-4401
Phone (770) 834-0873

Other identifiers 1

IdentifierTypeStateIssuer
REF000630555MedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140729000721 GA Practitioner - Orthopedic Surgery 0648413922 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Medical College of Georgia School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Esop Rehabilitation LLCGroup PAC ID 9739305749, shared by 9 NPIs, 224 clinicians
Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians
Gwinnett Clinic, LTDGroup PAC ID 9436061801, 44 clinicians

Practice addresses (Care Compare)

1699 Hwy 124 N
Snellville, GA 30078-7921
Phone (678) 218-6702

3605 Braselton Hwy
Dacula, GA 30019-4666
Phone (770) 904-0772

475 Philip Blvd
Suite 100
Lawrenceville, GA 30046-8736
Phone (678) 226-6202

966 A Killian Hill Rd SW
Lilburn, GA 30047-3102
Phone (770) 923-4815

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
72107GAMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carrollton Orthopaedic Clinic PC Sports Medicine CurrentSince Sep 1, 2014 Accepting new patients
Gwinnett Clinic, LTD CurrentSince Jan 1, 2025 Accepting new patients
Gwinnett Clinic, LTD CurrentSince Jan 1, 2025 Accepting new patients
Gwinnett Clinic LTD Current Accepting new patients
Gwinnett Clinic, LTD Past Accepting new patients

Locations

150 Clinic Ave
Carrollton, GA 30117
Phone (770) 834-0873

150 Clinic Ave
Ste 101
Carrollton, GA 30117
Phone (770) 834-0873

475 Philip Blvd
Ste 100
Lawrenceville, GA 30046
Phone (678) 226-6202

475 Philip Blvd
Ste 100301
Lawrenceville, GA 30046
Phone (770) 923-7301

2764 W Main St
Snellville, GA 30078
Phone (770) 978-3388

Interoperability endpoints

  • Direct secure messaging: shomari.ruffin.1@32352.direct.athenahealth.com

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414627200000",
    "number": "1114185840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 CLINIC AVE",
            "address_2": "SUITE 101",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174401",
            "telephone_number": "770-834-0873",
            "fax_number": "770-834-6118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 CLINIC AVE",
            "address_2": "SUITE 101",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174401",
            "telephone_number": "770-834-0873",
            "fax_number": "770-834-6118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUFFIN",
        "first_name": "SHOMARI",
        "middle_name": "ANDRE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-29",
        "last_updated": "2014-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "GA",
            "license": "72107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "REF000630555",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.