NPIMap

Organization Active NPI

Pediatric Associates LLP

  • Pediatrics Physician
  • Gainesville, GA
National Provider Identifier
1245406719
Registry record updated Jun 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC ASSOCIATES LLP
Practice address
1485 Jesse Jewell Pkwy NE
Suite 200
Gainesville, GA 30501-3806
Phone
(770) 534-5255
Fax
(770) 287-3871
NPI assigned
May 5, 2008
Last updated
Jun 19, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2012

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

Authorized official

Name
Lori C Hare
Title
Billing Manager
Phone
(770) 534-5255

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1485 Jesse Jewell Pkwy NE
Suite 200
Gainesville, GA 30501-3806

Mailing address

1485 Jesse Jewell Pkwy NE
Suite 200
Gainesville, GA 30501-3806
Phone (770) 534-5255

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210218000623 GA Part B Supplier - Mass Immunization (Roster Biller Only) 0345655692 Practice locations: Gainesville, GA

National Provider Directory

National Provider Directory

Locations

2695 Old Winder Hwy
Ste 200
Braselton, GA 30517
Phone (770) 965-6894

1485 Jesse Jewell Pkwy NE
Ste 20
Gainesville, GA 30501

1485 Jesse Jewell Pkwy NE
Ste 200
Gainesville, GA 30501
Phone (770) 534-5255

1485 Jesse Jewell Pkwy NE
Ste 200A
Gainesville, GA 30501
Phone (770) 534-5255

200 S Enota Dr NE
Ste 150
Gainesville, GA 30501
Phone (770) 219-3202

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1209945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340064000000",
    "number": "1245406719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1485 JESSE JEWELL PKWY NE",
            "address_2": "SUITE 200",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013806",
            "telephone_number": "770-534-5255",
            "fax_number": "770-287-3871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1485 JESSE JEWELL PKWY NE",
            "address_2": "SUITE 200",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013806",
            "telephone_number": "770-534-5255",
            "fax_number": "770-287-3871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-05",
        "last_updated": "2012-06-19",
        "status": "A",
        "authorized_official_last_name": "HARE",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "770-534-5255"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.