Ericka Vanesa Li Fuentes, M.D
Individual provider Active NPI Internal Medicine Physician · Macon, GA
NPI 1295048213 · NPPES record last updated Mar 4, 2019
Key facts
- NPI
- 1295048213
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 070321 (GA)
- Practice address
- 777 Hemlock St
Macon, GA 31201-2102 - Phone
- (478) 301-2362
- NPI assigned
- Jul 19, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Privia Medical Group of Georgia LLC
Practice addresses (Care Compare)
101 Yorktown Dr
Fayetteville, GA 30214-1578
764 Pine St
Macon, GA 31201-2107
Phone (478) 633-1721
777 Hemlock St
Macon, GA 31201-2102
Phone (478) 633-1000
Hospital & facility affiliations
- Atrium Health Navicent the Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130805000684 | GA | Practitioner - Internal Medicine | 8123260106 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301097388 | MI | MD | Internal Medicine Physician |
| 35-131721 | OH | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Privia Medical Group of Georgia LLC | Internal Medicine | Current |
Accepting new patients |
| Privia Medical Group of Georgia LLC | Internal Medicine | Current |
Accepting new patients |
| The Corporation of Mercer University | Internal Medicine | Current | Accepting new patients |
| Movement Sports Physical Therapy, LLC | Current |
Accepting new patients | |
| The Medical Center of Central Georgia Inc | Past | Accepting new patients |
Locations
101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285
777 Hemlock St
Macon, GA 31201
Phone (478) 474-5600
250 Mlk Blvd
Macon, GA 31201
Phone (478) 301-2362
1550 College St
Macon, GA 31207
Phone (478) 301-2600
764 Pine St
Macon, GA 31201
Phone (478) 633-1056
Interoperability endpoints
- https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301097388 | MI | |
| Internal Medicine Physician | 207R00000X | 35-131721 | OH | |
| Internal Medicine Physician | 207R00000X | 070321 | GA | Yes |
Addresses
Primary practice location
777 Hemlock St
Macon, GA 31201-2102
Mailing address
250 Martin Luther King Jr Blvd
Macon, GA 31201-3490
Phone (478) 301-2362
Other providers in Macon, GA
- Natalie Latash Lewis
- Phoeby K Lewis
- Regina L Lewis
- Torrance R Lewis
- William S Lewis
- Gande Li
- Michelle Li
- Delson Liberal
- Life and Living Companion Care LLC
- Life Line Home Care Inc
All providers in Macon, GA · Internal Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.