Elleni Kebede, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN205026 Issued in GA

Practice address

2450 Old Milton Pkwy
Alpharetta, GA 30009-2250

Phone

(470) 267-0360

NPI assigned

May 26, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bold Legacy Practice, LLCGroup PAC ID 5799140430, 3 clinicians

Bold Primary LLCGroup PAC ID 6406298249, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Bold Legacy Practice, LLC

  • Urgent Care Clinic/Center
  • Marietta, GA
  • NPI 1972212116
  Medicare reassignment Care Compare group NPD
• Bold Primary LLC

  • Family Medicine Physician
  • Marietta, GA
  • NPI 1275300287
  Medicare reassignment Care Compare group NPD
• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD

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

{
    "created_epoch": "1685059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685059200000",
    "number": "1124711064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 LYNDHURST WAY",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300752583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 OLD MILTON PKWY",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300092250",
            "telephone_number": "470-267-0360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEBEDE",
        "first_name": "ELLENI",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-26",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN205026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah G Katta, M.D.
• Cecelia Waldrop Kauffman, M.A. CCC-SLP
• Kenneth B Kay
• Yusuf Kazmi
• Jessica KC, PMHNP
• Diane K Kee, MSRNCS
• Kyra Keenan, BCBA
• Susan L Keenan, LPC, NCC
• Kaitlyn Morgan Keeney
• James Alvin Keith Jr., DDS

• Family Nurse Practitioner in Alpharetta, GA
• Providers in Alpharetta, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.