NPIMap

Organization Active NPI

Cornerstone Medical Group

  • Internal Medicine Physician
  • Dalton, GA
National Provider Identifier
1275515967
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CORNERSTONE MEDICAL GROUP
Practice address
914 Vista Drive
Dalton, GA 30721-8654
Phone
(706) 226-3139
Fax
(706) 278-6606
NPI assigned
Nov 17, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Authorized official

Name
Eric Jensen, M.D.NPI 1235136052
Title
President
Phone
(706) 226-3139

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

914 Vista Drive
Dalton, GA 30721-8654

Mailing address

914 Vista Drive
Dalton, GA 30721-8654
Phone (706) 226-3139

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040806000991 GA Part B Supplier - Clinic/Group Practice 3971575390 Receives reassigned benefits from 8 practitioners
Practice locations: Dalton, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0693402Cornerstone Medical Group914 Vista Drive, Dalton, GA 30721ComplianceMay 25, 2027

National Provider Directory

National Provider Directory

Locations

1107 Memorial Dr
Ste 300
Dalton, GA 30720
Phone (706) 226-3139

914 Vista Dr
Dalton, GA 30721
Phone (706) 226-3139

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.401

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1275515967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 VISTA DRIVE",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307218654",
            "telephone_number": "706-226-3139",
            "fax_number": "706-278-6606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 VISTA DRIVE",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307218654",
            "telephone_number": "706-226-3139",
            "fax_number": "706-278-6606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-17",
        "last_updated": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-226-3139",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.