Individual provider Active NPI

Douglas A Laross, D.C.

  • Chiropractor
  • Acworth, GA
National Provider Identifier
1225127855
Registry record updated Aug 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6046 Issued in GA
Practice address
2538 Cedarcrest Rd
Ste. 113
Acworth, GA 30101-8293
Phone
(770) 222-7555
Fax
(770) 222-1919
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 6046 GA Primary

Addresses

Primary practice location

2538 Cedarcrest Rd
Ste. 113
Acworth, GA 30101-8293

Mailing address

2538 Cedarcrest Rd
Ste. 113
Acworth, GA 30101-8293
Phone (770) 222-7555

Other identifiers 2

IdentifierTypeStateIssuer
58-2659125OtherGAFEDERAL TAX ID
198-09-00-VLOtherGAGEORGIA STATE TAX ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130318000236 GA Practitioner - Chiropractic 6002985900 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2538 Cedarcrest Rd
Suite 113
Acworth, GA 30101-2727
Phone (770) 222-7555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6046GAMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hiram Chiropractic Chiropractor CurrentSince Oct 1, 2001 Accepting new patients

Locations

2538 Cedarcrest Rd
Ste 113
Acworth, GA 30101
Phone (770) 222-7555

4484 Jimmy Lee Smith Pkwy
Ste F201
Hiram, GA 30141
Phone (770) 222-7555

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472515200000",
    "number": "1225127855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2538 CEDARCREST RD",
            "address_2": "STE. 113",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301018293",
            "telephone_number": "770-222-7555",
            "fax_number": "770-222-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2538 CEDARCREST RD",
            "address_2": "STE. 113",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301018293",
            "telephone_number": "770-222-7555",
            "fax_number": "770-222-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAROSS",
        "first_name": "DOUGLAS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2016-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "6046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID",
            "identifier": "58-2659125",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA STATE TAX ID",
            "identifier": "198-09-00-VL",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Acworth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; 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.