Premier Primary Care, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PREMIER PRIMARY CARE, LLC

Practice address

2121 Fountain Dr Ste a
Snellville, GA 30078-2900

Phone

(770) 736-3008

Fax

(770) 687-2296

NPI assigned

Feb 15, 2019

Organization subpart

No

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

Authorized official

Name

Ms. Amanda Crawford

Title

Practice Administrator

Phone

(770) 736-3008

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EJHDAD
• FHIR API: https://fhir4.healow.com/fhir/r4/JFEICA

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jose Luis Dominguez, MD

  • Internal Medicine Physician
  • Snellville, GA
  • NPI 1295835775
  Medicare reassignment Care Compare group NPD
• Daryl Sherrod, M.D.

  • Family Medicine Physician
  • Fayetteville, GA
  • NPI 1851354740
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1550188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563494400000",
    "number": "1154887925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 FOUNTAIN DR STE A",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782900",
            "telephone_number": "770-736-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 FOUNTAIN DR STE A",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782900",
            "telephone_number": "770-736-3008",
            "fax_number": "770-687-2296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-15",
        "last_updated": "2019-07-19",
        "status": "A",
        "authorized_official_last_name": "CRAWFORD",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "770-736-3008",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prestige Pharmacy Snellville LLC

• Internal Medicine Physician in Snellville, GA
• Providers in Snellville, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.