NPIMap

Individual provider Active NPI

Lawrence Ukpong, DO

  • Cardiovascular Disease Physician
  • Moultrie, GA
National Provider Identifier
1376700807
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
071293 Issued in GA
Practice address
1 Sweet Bay CT
Moultrie, GA 31768-6756
Phone
(229) 891-9087
NPI assigned
May 21, 2008
Last updated
Apr 4, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 071293 GA Primary

Addresses

Primary practice location

1 Sweet Bay CT
Moultrie, GA 31768-6756

Mailing address

1 Sweet Bay CT
Moultrie, GA 31768-6756
Phone (229) 891-9087

Other identifiers 2

IdentifierTypeStateIssuer
202I064468OtherGAMEDICARE PTAN
003143092AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140306000730 GA Practitioner - Cardiovascular Disease (Cardiology) 5698801314 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Ohio University, College of Osteopathic Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1 Sweet Bay Court
Moultrie, GA 31768-6756
Phone (229) 891-9087

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
071293GAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lawrence a Ukpong MD PC Cardiovascular Disease CurrentSince Apr 1, 2023 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
Hospitalist Medicine Physicians of Ashland County, LTD. Past Accepting new patients

Locations

1 Sweet Bay Ct
Moultrie, GA 31768
Phone (229) 890-5305

1 Sweet Bay Ct
Ste B
Moultrie, GA 31768
Phone (229) 890-5305

Organizations & group practices 3

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

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680566400000",
    "number": "1376700807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SWEET BAY CT",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686756",
            "telephone_number": "229-891-9087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SWEET BAY CT",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686756",
            "telephone_number": "229-891-9087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UKPONG",
        "first_name": "LAWRENCE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-21",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "071293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "202I064468",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003143092A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moultrie, GA

Sources for this page

Verify at the official NPI Registry.