Ngoc Bao Phan, D.O

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

73360 Issued in GA

Practice address

625 Beaver Ruin Rd NW Ste E
Lilburn, GA 30047-3407

Phone

(678) 369-9399

Fax

(833) 464-3867

NPI assigned

Jun 8, 2012

Last updated

Oct 28, 2024By the provider in NPPES

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 GA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Internal Medicine

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Gwinnett Hospital, Lawrenceville, GA, CCN 110087
• Northside Hospital Duluth Hospital, Duluth, GA, CCN 110252
• Northside Hospital Hospital, Atlanta, GA, CCN 110161
• Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ngoc.phan.1@27557.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Truecare Medical LLC

  • Internal Medicine Physician
  • Lilburn, GA
  • NPI 1528731205
  Medicare reassignment NPD Authorized official
• Northeast Georgia Physicians Group Inc

  • Family Medicine Physician
  • Gainesville, GA
  • NPI 1891745212

  Internal Medicine

  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northside Hospital, Inc.

  dba Northside Hospital Forsyth

  • General Acute Care Hospital
  • Cumming, GA
  • NPI 1376574277
  Care Compare affiliation
• Northside Hospital, Inc.

  dba Northside Hospital

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1457396079
  Care Compare affiliation
• Northside Hospital, Inc.

  dba Northside Hospital Duluth

  • General Acute Care Hospital
  • Duluth, GA
  • NPI 1790715381
  Care Compare affiliation
• Northside Hospital, Inc.

  dba Northside Hospital Gwinnett

  • General Acute Care Hospital
  • Lawrenceville, GA
  • NPI 1952340994
  Care Compare affiliation

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

{
    "created_epoch": "1339113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1215299086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 BEAVER RUIN RD NW STE E",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473407",
            "telephone_number": "678-369-9399",
            "fax_number": "770-733-1370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 BEAVER RUIN RD NW STE E",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473407",
            "telephone_number": "678-369-9399",
            "fax_number": "833-464-3867"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "302 Satellite Blvd NE Ste 109&110",
            "address_purpose": "LOCATION",
            "city": "Suwanee",
            "state": "GA",
            "postal_code": "300247181",
            "country_code": "US",
            "telephone_number": "678-369-9399",
            "fax_number": "833-464-3867",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAN",
        "first_name": "NGOC",
        "middle_name": "BAO",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-08",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "73360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Brooke Perkins
• Amara Janae Perodin
• Vacie Perry, RBT
• Britannica Peterson
• Hong Huong Thi Pham
• Physiotherapy Associates Inc (Physio-Gwinnett)
• Tkeyah Kiana Piankhi
• Alexander Pikus, DMD
• Aziz A Pirani, MD
• Lauren Kelli Pittman, WHNP-BC

• Internal Medicine Physician in Lilburn, GA
• Providers in Lilburn, 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 Oct 28, 2024; 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.