Individual provider Active NPI

Jerrica Conyers

  • Nurse Practitioner
  • Newnan, GA
National Provider Identifier
1225652936
Registry record updated May 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN210430 Issued in GA
Practice address
1635 Highwat 34 East Suite C,
Newnan, GA 30265
Phone
(678) 619-5151
NPI assigned
May 29, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN210430 GA Primary

Addresses

Primary practice location

1635 Highwat 34 East Suite C,
Newnan, GA 30265

Mailing address

360877
Decatur, GA 30034

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20220113000448 GA Practitioner - Nurse Practitioner 0042602559 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstreet of Georgia PCGroup PAC ID 7517126279, 425 clinicians

Practice addresses (Care Compare)

1280 Dogwood Dr SE
Conyers, GA 30013-5046
Phone (404) 994-4662

2292 Peachtree Rd
Atlanta, GA 30309-1147
Phone (404) 382-9941

2410 Ingleside Ave
Macon, GA 31204-2036
Phone (678) 695-6960

3366 Hwy 42 S
Suite 100
Locust Grove, GA 30248-3014
Phone (470) 759-2085

4475 W Village Pkwy
Ellenwood, GA 30294-2869
Phone (770) 507-7950

500 Nathan Dean Blvd
Suite 105
Dallas, GA 30157-4911
Phone (470) 624-6793

5239 Hwy 278 NE
Covington, GA 30014-2671
Phone (678) 660-5106

5585 Thomaston Rd
A600
Macon, GA 31220-8200
Phone (478) 354-4200

5791 Zebulon Rd
Suite a
Macon, GA 31210-2025
Phone (478) 845-4640

882 Ponce de Leon Ave
Atlanta, GA 30306-4268
Phone (770) 809-3034

921 Eagles Landing Pkwy
Stockbridge, GA 30281-5011
Phone (770) 660-5106

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstreet of Georgia PC CurrentSince Jan 1, 2022 Accepting new patients

Locations

2292 Peachtree Rd NW
Atlanta, GA 30309
Phone (404) 382-9941

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": "1590710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590710400000",
    "number": "1225652936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360877",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "30034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 HIGHWAT 34 EAST SUITE C,",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "30265",
            "telephone_number": "678-619-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONYERS",
        "first_name": "JERRICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-29",
        "last_updated": "2020-05-29",
        "certification_date": "2020-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN210430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newnan, GA

Sources for this page

Verify at the official NPI Registry.