NPIMap

Organization Active NPI

Peach State Medical Practice, PC

  • Reproductive Endocrinology Physician
  • Washington, DC
National Provider Identifier
1306500665
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Reproductive Endocrinology PhysicianTaxonomy code 207VE0102X
Legal business name
PEACH STATE MEDICAL PRACTICE, PC
Practice address
1111 19TH St NW
Washington, DC 20036-3603
Phone
(855) 563-2639
NPI assigned
Oct 23, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Authorized official

Name
Fahimeh Sasan, DO
Title
Founding OBGYN
Phone
(855) 563-2639

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Reproductive Endocrinology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VE0102X Primary

Addresses

Primary practice location

1111 19TH St NW
Washington, DC 20036-3603

Mailing address

333 S Desplaines St Ste 201
Chicago, IL 60661-5514
Phone (855) 563-2639

Other names 1

  • Kindbody of DC Medical Practice Doing business as

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
09D2240389Peach State Medical Practice PC Dba Kindbody of DC1111 19TH Street NW #104, Washington, DC 20036AccreditationJan 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Peach State Medical Practice PC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

3005 Peachtree Rd NE
Ste 100
Atlanta, GA 30305
Phone (470) 765-6347

NPI Registry JSON

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

{
    "created_epoch": "1634947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716163200000",
    "number": "1306500665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 S DESPLAINES ST STE 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606615514",
            "telephone_number": "855-563-2639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 19TH ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200363603",
            "telephone_number": "855-563-2639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH STATE MEDICAL PRACTICE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-23",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A",
        "authorized_official_last_name": "SASAN",
        "authorized_official_first_name": "FAHIMEH",
        "authorized_official_title_or_position": "FOUNDING OBGYN",
        "authorized_official_telephone_number": "855-563-2639",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VE0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kindbody of DC Medical Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kindbody of DC Medical Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.