Organization Active NPI

Relymd Virtual Health Ga, LLC

  • Emergency Medicine Physician
  • Atlanta, GA
National Provider Identifier
1386414720
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
RELYMD VIRTUAL HEALTH GA, LLC
Practice address
5665 New Northside Dr Ste 320
Atlanta, GA 30328-5834
Phone
(770) 874-5400
NPI assigned
Jan 8, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Authorized official

Name
Kim Larsen
Title
Director of Credentialing
Phone
(770) 874-5400

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

5665 New Northside Dr Ste 320
Atlanta, GA 30328-5834

Mailing address

5665 New Northside Dr Ste 320
Atlanta, GA 30328-5834
Phone (770) 874-5400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, LA, CO, MI, FL, MA, NY, GA, VA, UT, TX, ID, CA, NJ, HI, SC, AZ, NH18 enrollments

Enrollment records 18

Enrollment IDStateProvider typePAC IDDetails
O20240709001364 PA Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 1 practitioner
Practice locations: Philadelphia, PA
O20240710003661 LA Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 1 practitioner
Practice locations: New Orleans, LA
O20240721000046 CO Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 3 practitioners
Practice locations: Denver, CO; Boulder, CO; Loveland, CO
O20240723003532 MI Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 1 practitioner
Practice locations: Iron River, MI
O20240726000080 FL Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 7 practitioners
Practice locations: Jacksonville Beach, FL; Thonotosassa, FL; Parkland, FL; Miami, FL; Gulf Breeze, FL; Boca Raton, FL
O20240729001775 MA Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 1 practitioner
Practice locations: Sudbury, MA
O20240729001945 NY Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 1 practitioner
Practice locations: Hammondsport, NY
O20240809000635 GA Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 9 practitioners
Practice locations: Kennesaw, GA; Smyrna, GA; Roswell, GA; Marietta, GA; Decatur, GA; Atlanta, GA
O20241120004368 VA Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 2 practitioners
Practice locations: Ashburn, VA; Leesburg, VA
O20241206002012 UT Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 1 practitioner
Practice locations: Santa Clara, UT
O20250107002682 TX Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 1 practitioner
Practice locations: El Paso, TX
O20250110002830 ID Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 1 practitioner
Practice locations: Hailey, ID
O20250113002709 CA Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 4 practitioners
Practice locations: Calabasas, CA; Lemon Grove, CA; San Francisco, CA
O20250401002472 NJ Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 1 practitioner
Practice locations: Cresskill, NJ
O20250506003197 HI Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 6 practitioners
Practice locations: Honolulu, HI; Mililani, HI
O20251031004235 SC Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 1 practitioner
Practice locations: Johns Island, SC
O20260407000785 AZ Part B Supplier - Clinic/Group Practice 2466997945 Practice locations: Parker, AZ
O20260520002089 NH Part B Supplier - Clinic/Group Practice 2466997945 Receives reassigned benefits from 1 practitioner
Practice locations: Nashua, NH

National Provider Directory

National Provider Directory

Locations

22421 Barton Rd
#21301
Grand Terrace, CA 92313
Phone (949) 201-9995

518 Julia St
New Orleans, LA 70130
Phone (415) 271-7300

25 Trafalgar Sq
Nashua, NH 03063

Practitioners & affiliated clinicians

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1386414720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5665 NEW NORTHSIDE DR STE 320",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303285834",
            "telephone_number": "770-874-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5665 NEW NORTHSIDE DR STE 320",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303285834",
            "telephone_number": "770-874-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RELYMD VIRTUAL HEALTH GA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-02",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "770-874-5400"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 8, 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.