Individual provider Active NPI

Reagan Brooke Morgan, PA-C

  • Dermatology Physician
  • Marietta, GA
National Provider Identifier
1295413805
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
11702 Issued in GA
Practice address
111 Marble Mill Rd NW
Marietta, GA 30060-1047
Phone
(770) 422-1013
Fax
(770) 514-5996
NPI assigned
Jul 5, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 11702 GA Primary

Addresses

Primary practice location

111 Marble Mill Rd NW
Marietta, GA 30060-1047

Mailing address

765 Woodbrook Way
Lawrenceville, GA 30043-6854
Phone (770) 361-1275

Other practice location 1

605 S Enota Dr NE
Gainesville, GA 30501-2437
Phone (770) 538-0208

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230811002355 GA Practitioner - Physician Assistant 6002278702 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Mercer University School of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marietta Dermatology Associates PAGroup PAC ID 6507850120, 22 clinicians

Practice addresses (Care Compare)

111 Marble Mill NWRD
Marietta, GA 30060-1047

111 Marble Mill Rd NW
Marietta, GA 30060-1047
Phone (770) 422-1013

130 Oakside CT
Suite a
Canton, GA 30114-2456
Phone (770) 422-1013

Merit-based Incentive Payment System (MIPS)

Final score
92.21 of 100Reported as group
Quality
100
Improvement activities
40
Cost
74.03

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1688515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1295413805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 WOODBROOK WAY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300436854",
            "telephone_number": "770-361-1275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MARBLE MILL RD NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601047",
            "telephone_number": "770-422-1013",
            "fax_number": "770-514-5996"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "605 S Enota Dr NE",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305012437",
            "country_code": "US",
            "telephone_number": "770-538-0208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORGAN",
        "first_name": "REAGAN",
        "middle_name": "BROOKE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-05",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "11702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.