Individual provider Active NPI

Douglas Krug

  • Emergency Medicine Physician
  • Austell, GA
National Provider Identifier
1235230962
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
22806 Issued in GA
Practice address
3950 Austell Rd
Austell, GA 30106-1121
Phone
(770) 732-4000
NPI assigned
Sep 26, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 22806 GA Primary

Addresses

Primary practice location

3950 Austell Rd
Austell, GA 30106-1121

Mailing address

5665 New Northside Dr NW
Atlanta, GA 30328-5831
Phone (770) 874-5400

Other identifiers 1

IdentifierTypeStateIssuer
00227037HMedicaidGA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080605000004 GA Practitioner - Emergency Medicine 7315017159 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
22806GAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Bortolazzo Group, LLC Emergency Medicine CurrentSince Jul 1, 2008 Accepting new patients

Locations

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

600 W Memorial Dr
Dallas, GA 30132
Phone (770) 443-7072

677 Church St NE
Marietta, GA 30060
Phone (770) 793-5435

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1235230962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5665 NEW NORTHSIDE DR NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303285831",
            "telephone_number": "770-874-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 AUSTELL RD",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061121",
            "telephone_number": "770-732-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUG",
        "first_name": "DOUGLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "22806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00227037H",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austell, GA

Sources for this page

Verify at the official NPI Registry.