NPIMap

Organization Active NPI

Pediatrix Medical Group of Georgia, P.C.

Doing business as Pediatrix Medical Group of Central Georgia

  • Neonatal-Perinatal Medicine Physician
  • Sunrise, FL
National Provider Identifier
1295827574
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
Legal business name
PEDIATRIX MEDICAL GROUP OF GEORGIA, P.C.
Doing business as
Pediatrix Medical Group of Central Georgia
Practice address
1301 Concord Ter
Sunrise, FL 33323-2843
Phone
(954) 384-0175
Fax
(954) 851-1948
NPI assigned
Sep 28, 2006
Last updated
Nov 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

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

Authorized official

Name
Dr. Michael D Dwyer
Title
Assistant Secretary
Phone
(954) 384-0175

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Maternal & Fetal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VM0101X
Neonatal-Perinatal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080N0001X Primary
Pediatric Critical Care Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0203X

Addresses

Primary practice location

1301 Concord Ter
Sunrise, FL 33323-2843

Mailing address

1301 Concord Ter
Sunrise, FL 33323-2843
Phone (954) 384-0175

Other names 1

  • Pediatrix Medical Group of Central Georgia Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040728000431 GA Part B Supplier - Clinic/Group Practice 7416927447 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
Practice locations: Athens, GA; Watkinsville, GA; Villa Rica, GA; Stockbridge, GA; Marietta, GA; Lawrenceville, GA; Fayetteville, GA; Cumming, GA…

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

3400 Old Milton Pkwy
Ste A410
Alpharetta, GA 30005
Phone (678) 805-2446

1288 Wellbrook Cir NE
Ste B
Conyers, GA 30012
Phone (678) 487-5920

4150 Dep Bill Cantrell Memorial Rd
Ste 120
Cumming, GA 30040
Phone (678) 805-2246

4150 Dep Bill Cantrell Memorial Rd
Ste 150
Cumming, GA 30040

2665 N Decatur Rd
Ste 440
Decatur, GA 30033
Phone (404) 298-0921

2665 N Decatur Rd
Ste 750
Decatur, GA 30033
Phone (770) 279-3838

8954 Hospital Dr
Douglasville, GA 30134
Phone (678) 838-2584

980 Johnson Fy Rd NE
Ste 620
Sandy Springs, GA 30342
Phone (404) 252-9751

1272 Virgil Langford Rd
Ste 101
Watkinsville, GA 30677
Phone (706) 449-0273

Practitioners & affiliated clinicians

Practitioners 58

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 58

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732147200000",
    "number": "1295827574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 CONCORD TER",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232843",
            "telephone_number": "954-384-0175",
            "fax_number": "954-851-1948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 CONCORD TER",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232843",
            "telephone_number": "954-384-0175",
            "fax_number": "954-851-1948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIX MEDICAL GROUP OF GEORGIA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A",
        "authorized_official_last_name": "DWYER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "954-384-0175",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207VM0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatrix Medical Group of Central Georgia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatrix Medical Group of Central Georgia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sunrise, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; 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.