NPIMap

Organization Active NPI

Peachtree Orthopaedic Clinic P.a.

Doing business as Peachtree Orthopaedic Physical Therapy

  • Physical Therapist
  • Atlanta, GA
National Provider Identifier
1306022264
Registry record updated Jan 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PEACHTREE ORTHOPAEDIC CLINIC P.A.
Doing business as
Peachtree Orthopaedic Physical Therapy
Practice address
5505 Peachtree Dunwoody Rd NE
Suite 250
Atlanta, GA 30342-1705
Phone
(404) 425-1577
NPI assigned
Jan 10, 2008
Last updated
Jan 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2008

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

Authorized official

Name
Mr. Gregory L Cooper
Title
Managing Partner
Phone
(219) 365-6560

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X GA Primary
Occupational TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225X00000X GA

Addresses

Primary practice location

5505 Peachtree Dunwoody Rd NE
Suite 250
Atlanta, GA 30342-1705

Mailing address

8259 Wicker Ave
Saint John, IN 46373-8878
Phone (219) 365-6560

Other names 1

  • Peachtree Orthopaedic Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040308000751 GA Part B Supplier - Clinic/Group Practice 4587552963 Receives reassigned benefits from 145 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alpharetta, GA; Woodstock, GA; Marietta, GA; Duluth, GA; Dawsonville, GA; Cumming, GA; College Park, GA; Atlanta, GA

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Peachtree Orthopaedic C17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199923200000",
    "number": "1306022264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8259 WICKER AVE",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463738878",
            "telephone_number": "219-365-6560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5505 PEACHTREE DUNWOODY RD NE",
            "address_2": "SUITE 250",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421705",
            "telephone_number": "404-425-1577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE ORTHOPAEDIC CLINIC P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-10",
        "last_updated": "2008-01-10",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "219-365-6560",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peachtree Orthopaedic Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; 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.