Individual provider Active NPI

Ronald A Homer, MD

  • Pediatrics Physician
  • Tucker, GA
National Provider Identifier
1124072822
Registry record updated Apr 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
050105 Issued in GA
Practice address
1370 Montreal Rd
Ste 180
Tucker, GA 30084
Phone
(404) 446-4600
Fax
(404) 446-4601
NPI assigned
May 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 14, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 050105 GA Primary

Addresses

Primary practice location

1370 Montreal Rd
Ste 180
Tucker, GA 30084

Mailing address

1370 Montreal Rd
Ste 180
Tucker, GA 30084
Phone (404) 446-4600

Other identifiers 1

IdentifierTypeStateIssuer
000940266KMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
050105GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dekalb Pediatric Associates PC Pediatrics Past Accepting new patients
University Physicians Group P C Pediatrics Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FCBBAA/Endpoint/FCBBAA
  • FHIR API: https://fhir4.healow.com/fhir/r4/FCBBAA
  • Direct secure messaging: ronald.homer@dpapeds.eclinicaldirectplus.com

Organizations & group practices 2

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": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302739200000",
    "number": "1124072822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1370 MONTREAL RD",
            "address_2": "STE 180",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "30084",
            "telephone_number": "404-446-4600",
            "fax_number": "404-446-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 MONTREAL RD",
            "address_2": "STE 180",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "30084",
            "telephone_number": "404-446-4600",
            "fax_number": "404-446-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOMER",
        "first_name": "RONALD",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2011-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "050105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000940266K",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucker, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.