NPIMap

Organization Active NPI

Peachtree Hospice of Georgia, LLC

Doing business as BridgeWay Palliative Care

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Stockbridge, GA
National Provider Identifier
1255788436
Registry record updated May 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
Legal business name
PEACHTREE HOSPICE OF GEORGIA, LLC
Doing business as
BridgeWay Palliative Care
Practice address
354 Corporate Center CT
Stockbridge, GA 30281-6360
Phone
(678) 583-2269
Fax
(678) 583-2270
NPI assigned
May 18, 2016
Last updated
May 18, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
PEACHTREE HOSPICE OF GEORGIA, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 18, 2016

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

Authorized official

Name
Gary W Rasmussen
Title
President
Phone
(678) 932-6302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X Primary

Addresses

Primary practice location

354 Corporate Center CT
Stockbridge, GA 30281-6360

Mailing address

1395 S Marietta Pkwy SE
BLDG 400 Suite 116
Marietta, GA 30067-4440
Phone (678) 932-6302

Other names 1

  • BridgeWay Palliative Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160902000940 GA Part B Supplier - Clinic/Group Practice 5496988156 Receives reassigned benefits from 41 practitioners
Practice locations: Canton, GA; Rome, GA; Stockbridge, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Peachtree Hospice Ga2 organizations share this tax ID, including this one
Part of
Peachtree Hospice Ga

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1395 S Marietta Pkwy SE
#B4
Marietta, GA 30067

1585 Highway 34 E
#B
Newnan, GA 30265
Phone (678) 583-2269

1605 Highway 34 E
Ste C
Newnan, GA 30265
Phone (678) 583-2269

1233 Eagles Landing Pkwy
Stockbridge, GA 30281
Phone (404) 480-3842

1233 Eagles Landing Pkwy
Ste A
Stockbridge, GA 30281
Phone (404) 480-3842

1233 Eagles Landing Pkwy
Ste Ab
Stockbridge, GA 30281
Phone (404) 480-3842

200 Business Center Dr
Stockbridge, GA 30281
Phone (678) 289-6044

200 Business Center Dr
Ste 204
Stockbridge, GA 30281
Phone (678) 583-2269

354 Corporate Center Ct
Stockbridge, GA 30281
Phone (678) 583-2269

234B Cherokee Rd
Thomaston, GA 30286
Phone (678) 583-2269

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Affinity HospiceStockbridge, GA, CCN 111734 Hospice 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Feb 4, 2014
Feb 4, 2014

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 45

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 45

NPI Registry JSON

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

{
    "created_epoch": "1463529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463529600000",
    "number": "1255788436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 S MARIETTA PKWY SE",
            "address_2": "BLDG 400 SUITE 116",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300674440",
            "telephone_number": "678-932-6302",
            "fax_number": "678-402-5246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 CORPORATE CENTER CT",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816360",
            "telephone_number": "678-583-2269",
            "fax_number": "678-583-2270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE HOSPICE OF GEORGIA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEACHTREE HOSPICE OF GEORGIA, LLC",
        "enumeration_date": "2016-05-18",
        "last_updated": "2016-05-18",
        "status": "A",
        "authorized_official_last_name": "RASMUSSEN",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-932-6302"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BridgeWay Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockbridge, GA

Sources for this page

Verify at the official NPI Registry.