NPIMap

Organization Active NPI

In Charge Medical Professionals LLC

  • Internal Medicine Physician
  • Peachtree City, GA
National Provider Identifier
1124426606
Registry record updated Jan 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
IN CHARGE MEDICAL PROFESSIONALS LLC
Practice address
21 Eastbrook BND Ste 218
Peachtree City, GA 30269-1546
Phone
(678) 967-5599
Fax
(866) 594-0037
NPI assigned
Dec 15, 2014
Last updated
Jan 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2020

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

Authorized official

Name
Kamran R QuraishiNPI 1417175068
Title
Owner
Phone
(502) 345-1561

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

21 Eastbrook BND Ste 218
Peachtree City, GA 30269-1546

Mailing address

21 Eastbrook BND Ste 218
Peachtree City, GA 30269-1546
Phone (678) 967-5599

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, WI, TN, MO4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20150220001634 IN Part B Supplier - Clinic/Group Practice 9436474178 Receives reassigned benefits from 27 practitioners
Practice locations: Indianapolis, IN
O20150316001131 WI Part B Supplier - Clinic/Group Practice 9436474178 Receives reassigned benefits from 2 practitioners
Practice locations: Brookfield, WI; Greendale, WI; Oconomowoc, WI; Pewaukee, WI; South Milwaukee, WI; Waukesha, WI
O20170629001430 TN Part B Supplier - Clinic/Group Practice 9436474178 Receives reassigned benefits from 2 practitioners
Practice locations: Chattanooga, TN
O20210603002170 MO Part B Supplier - Clinic/Group Practice 9436474178 Receives reassigned benefits from 10 practitioners
Practice locations: Saint Louis, MO

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1260 City Center Dr
Carmel, IN 46032
Phone (463) 333-9110

200 W Green Meadows Dr
Greenfield, IN 46140
Phone (317) 462-3311

259 W Harrison St
Fl 5
Mooresville, IN 46158

998 Woods Mill Rd
Ballwin, MO 63011
Phone (314) 658-3800

100 Medical Plz
#5
Lake Saint Louis, MO 63367

4930 Lindell Blvd
#100
Saint Louis, MO 63108

Practitioners & affiliated clinicians

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1418601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578009600000",
    "number": "1124426606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 EASTBROOK BND STE 218",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691546",
            "telephone_number": "678-967-5599",
            "fax_number": "866-594-0037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 EASTBROOK BND STE 218",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691546",
            "telephone_number": "678-967-5599",
            "fax_number": "866-594-0037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IN CHARGE MEDICAL PROFESSIONALS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-15",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A",
        "authorized_official_last_name": "QURAISHI",
        "authorized_official_first_name": "KAMRAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-345-1561"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peachtree City, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.