Individual provider Active NPI

Lori Ponder, CRNP

  • Family Nurse Practitioner
  • Rome, GA
National Provider Identifier
1235110263
Registry record updated Sep 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN147727 Issued in GA
Practice address
15 Riverbend Dr SW
Ste 100
Rome, GA 30161-6065
Phone
(706) 291-0884
Fax
(706) 378-8267
NPI assigned
Nov 8, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1-089350 AL
Family Nurse Practitioner 363LF0000X RN147727 GA Primary

Addresses

Primary practice location

15 Riverbend Dr SW
Ste 100
Rome, GA 30161-6065

Mailing address

15 Riverbend Dr SW
Ste 100
Rome, GA 30161-6065
Phone (706) 291-0884

Other identifiers 1

IdentifierTypeStateIssuer
205983747AMedicaidGA

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
I20080716000117 GA Practitioner - Nurse Practitioner 0941239057 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Floyd Healthcare Management IncGroup PAC ID 5193633386, 133 clinicians

Practice addresses (Care Compare)

1025 N Main St
Cedartown, GA 30125-2036
Phone (770) 748-5212

15 Riverbend Dr SW
Rome, GA 30161-6005
Phone (706) 291-0084

Hospital & facility affiliations

  • Atrium Health Floyd Medical Center Hospital, Rome, GA, CCN 110054

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
1-089350ALMDNurse Practitioner
RN147727GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Wound Care Nurse Practitioner CurrentSince Apr 26, 2004 Accepting new patients
Northwest Georgia Medical Clinic, P.C. CurrentSince Aug 23, 2009 Accepting new patients
Floyd Healthcare Management Inc Family CurrentSince Oct 1, 2023 Accepting new patients
Floyd Healthcare Management Inc CurrentSince Oct 1, 2023 Accepting new patients

Locations

402 S 6th St
Gadsden, AL 35901
Phone (256) 546-9558

1025 N Main St
Cedartown, GA 30125
Phone (770) 748-5212

15 Riverbend Dr SW
Rome, GA 30161
Phone (706) 291-0084

15 Riverbend Dr SW
Ste 100
Rome, GA 30161
Phone (706) 291-0884

Interoperability endpoints

  • Direct secure messaging: lponder2713860@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315267200000",
    "number": "1235110263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 RIVERBEND DR SW",
            "address_2": "STE 100",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301616065",
            "telephone_number": "706-291-0884",
            "fax_number": "706-378-8267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 RIVERBEND DR SW",
            "address_2": "STE 100",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301616065",
            "telephone_number": "706-291-0884",
            "fax_number": "706-378-8267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONDER",
        "first_name": "LORI",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-08",
        "last_updated": "2011-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-089350",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN147727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205983747A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rome, GA

Sources for this page

Verify at the official NPI Registry.