Jacqueline Alexandra Lilly, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

700 Churchill CT Ste 110
Woodstock, GA 30188-6880

Phone

(770) 284-9092

NPI assigned

Oct 21, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jacqueline Alexandra Ryanczak Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Privia Medical Group of Georgia LLCGroup PAC ID 4284951542, 454 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
• Direct secure messaging: jacqueline.lilly.1@8042.direct.athenahealth.com

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.

• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Fayetteville, GA
  • NPI 1013313857
  Medicare reassignment Care Compare group NPD
• Esfahani Enterprises LLC

  dba Thriveworks

  • Counseling Psychologist
  • Woodstock, GA
  • NPI 1457901340

  Mental Health

  NPD
• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Savannah, GA
  • NPI 1356907273
  NPD
• Thriveworks Woodstock

  • Adult Mental Health Clinic/Center
  • Woodstock, GA
  • NPI 1053929786
  NPD

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

{
    "created_epoch": "1571616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571616000000",
    "number": "1205479490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1734 TAPPAHANNOCK TRL",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300622087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 CHURCHILL CT STE 110",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301886880",
            "telephone_number": "770-284-9092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLY",
        "first_name": "JACQUELINE",
        "middle_name": "ALEXANDRA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-21",
        "last_updated": "2019-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "RYANCZAK",
            "middle_name": "ALEXANDRA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lindsey Liebenberg, LMFT
• Cindy Mary Lieu, PHARMD
• Life Clinic of Ga PC
• Life Well Lived Services, Inc.
• Lilium Therapy Services LLC
• Laura Anne Lim Sang
• Tracy Limes, LPC
• Limitless Disability Services
• Tanja Krutina Lindsey, M.D.
• Stephanie E Lionbarger, PHARMD

• Mental Health Counselor in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2019; 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.