Individual provider Active NPI

Tina Le Tran

  • Physician Assistant
  • Lagrange, GA
National Provider Identifier
1154045540
Registry record updated Apr 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12106 Issued in GA
Practice address
413 Lakeview Way
Lagrange, GA 30241-8792
Phone
(404) 647-3051
NPI assigned
Sep 28, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 12106 GA Primary

Addresses

Primary practice location

413 Lakeview Way
Lagrange, GA 30241-8792

Mailing address

413 Lakeview Way
Lagrange, GA 30241-8792
Phone (404) 647-3051

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250212000425 GA Practitioner - Physician Assistant 6507396173 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gastrointestinal Specialist of GeorgiaGroup PAC ID 9335032820, 35 clinicians

Practice addresses (Care Compare)

118 Mill St
Suite 100
Woodstock, GA 30188-4880
Phone (678) 741-5000

118 Mill St
Suite 110
Woodstock, GA 30188-4812
Phone (678) 741-5000

148 Bill Carruth Pkwy
Suite 200
Hiram, GA 30141-3756
Phone (678) 741-5000

711 Canton Rd
Suite 300
Marietta, GA 30060-1136
Phone (678) 741-5000

Hospital & facility affiliations

  • Wellstar Paulding Medical Center Hospital, Hiram, GA, CCN 110042

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12106GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Menke Investment, Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: tina.tran@gsg.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.

Hospital & facility affiliations 1

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": "1664323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1154045540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 LAKEVIEW WAY",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302418792",
            "telephone_number": "404-647-3051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 LAKEVIEW WAY",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302418792",
            "telephone_number": "404-647-3051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "TINA",
        "middle_name": "LE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-28",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrange, GA

Sources for this page

Verify at the official NPI Registry.