NPIMap

Individual provider Active NPI

Jason E Conley, MD

  • Emergency Medicine Physician
  • Cartersville, GA
National Provider Identifier
1215041496
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
054602 Issued in GA
Practice address
960 Joe Frank Harris Pkwy SE
Cartersville, GA 30120-2129
Phone
(770) 606-2104
NPI assigned
Aug 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 054602 GA Primary

Addresses

Primary practice location

960 Joe Frank Harris Pkwy SE
Cartersville, GA 30120-2129

Mailing address

5665 New Northside Dr NW
Suite 320
Atlanta, GA 30328-5831
Phone (770) 874-5400

Other identifiers 4

IdentifierTypeStateIssuer
409560395CMedicaidGA
409560395AMedicaidGA
409560395BMedicaidGA
409560395DMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040714000368 GA Practitioner - Emergency Medicine 6103805239 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
054602GAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Phoebe Putney Memorial Hospital CurrentSince Feb 1, 2014 Accepting new patients
Phoebe Putney Memorial Hospital Inc Current Accepting new patients
Phoebe Putney Memorial Hospital Inc CurrentSince Feb 1, 2014 Accepting new patients
Baxley Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Lavender Inpatient Services LLC Past Accepting new patients
The Bortolazzo Group, LLC Emergency Medicine PastSince Feb 9, 2020 Accepting new patients
Trail Crossing Emergency Physicians LLC Emergency Medicine Past Accepting new patients
South Fulton Emergency Physicians, LLC Emergency Medicine Past Accepting new patients

Locations

417 W 3rd Ave
Albany, GA 31701
Phone (229) 317-2207

2000 Palmyra Rd
Albany, GA 31701
Phone (229) 434-2000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1215041496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5665 NEW NORTHSIDE DR NW",
            "address_2": "SUITE 320",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303285831",
            "telephone_number": "770-874-5400",
            "fax_number": "770-874-5469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 JOE FRANK HARRIS PKWY SE",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301202129",
            "telephone_number": "770-606-2104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONLEY",
        "first_name": "JASON",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "054602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "409560395C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "409560395A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "409560395B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "409560395D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cartersville, GA

Sources for this page

Verify at the official NPI Registry.