Rolandine Vaughan, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10004230A Issued in IN

Practice address

1862 Auburn Rd Ste 118-X1
Dacula, GA 30019-1676

Phone

(404) 906-6985

Fax

(678) 302-7377

NPI assigned

Aug 8, 2008

Last updated

Mar 15, 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 5

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, NY, FL, OH, MN, CA, MI, IL, IN10 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 10

Specialty

Physician Assistant

Education

Eastern Virginia Medical School, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rolandine.vaughan@398008301912068.direct.elationemr.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.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• American Current Care PA

  dba Concentra Urgent Care

  • Urgent Care Clinic/Center
  • Addison, TX
  • NPI 1710168117

  GA

  Medicare reassignment NPD
• BP Immediate Medical Care, PC

  • Urgent Care Clinic/Center
  • Brooklyn, NY
  • NPI 1205105004

  Specialist

  Medicare reassignment NPD
• Hometown Urgent Care of Michigan, P.C.

  dba Hometown Urgent Care

  • Urgent Care Clinic/Center
  • Huber Heights, OH
  • NPI 1790030385

  MI

  Medicare reassignment NPD
• Treasure Coast Medical Associates

  dba Stuart Urgent Care

  • Emergency Medicine Physician
  • Jensen Beach, FL
  • NPI 1992791198
  Medicare reassignment NPD
• Georgia Em-I Medical Services. LLC

  • Nurse Practitioner
  • Bremen, GA
  • NPI 1851569560
  Medicare reassignment
• Gwinnett Emergency Specialists Observation Services, LLC

  • Emergency Medicine Physician
  • Lawrenceville, GA
  • NPI 1720373129
  Medicare reassignment
• Gwinnett Emergency Specialists, LLC

  • Emergency Medicine Physician
  • Lawrenceville, GA
  • NPI 1437346467
  Medicare reassignment
• Acs Primary Care Physicians - Southeast PC

  • Emergency Medicine Physician
  • Myrtle Beach, SC
  • NPI 1861430555

  GA

  Medicare reassignment
• Physicians Immediate Care North Chicago LLC

  • Urgent Care Clinic/Center
  • Chicago, IL
  • NPI 1205814118
  Medicare reassignment
• Pic Indiana PC

  dba WellNow Urgent Care

  • Urgent Care Clinic/Center
  • Mishawaka, IN
  • NPI 1942546890
  Medicare reassignment
• Wellnow Urgent Care, PC

  dba WellNow Urgent Care

  • Urgent Care Clinic/Center
  • Liverpool, NY
  • NPI 1669825162
  Medicare reassignment

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

{
    "created_epoch": "1218153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710460800000",
    "number": "1225284367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2084 MITFORD CT",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300192486",
            "telephone_number": "678-960-8953",
            "fax_number": "678-302-7377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1862 AUBURN RD STE 118-X1",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300191676",
            "telephone_number": "404-906-6985",
            "fax_number": "678-302-7377"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2084 Mitford Ct",
            "address_purpose": "LOCATION",
            "city": "Dacula",
            "state": "GA",
            "postal_code": "300192486",
            "country_code": "US",
            "telephone_number": "678-960-8953",
            "fax_number": "678-302-7377",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAUGHAN",
        "first_name": "ROLANDINE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-08",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "005982",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110002860",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "005982",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10004230A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Dacula, GA
• Providers in Dacula, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 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.