Individual provider Active NPI

Kory Greggs Vaughn, M.D.

  • Emergency Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1407105232
Registry record updated Feb 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MT197942 Issued in PA
Practice address
640 N Broad St
Apt 101
Philadelphia, PA 19130-3420
Phone
(678) 596-4621
NPI assigned
Sep 7, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MT197942 PA Primary

Addresses

Primary practice location

640 N Broad St
Apt 101
Philadelphia, PA 19130-3420

Mailing address

640 N Broad St
Apt 101
Philadelphia, PA 19130-3420

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130624000245 GA Practitioner - Emergency Medicine 4385883347 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Morehouse School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coweta Emergency Group LLCGroup PAC ID 5395876452, 28 clinicians

Practice addresses (Care Compare)

745 Poplar Rd
Newnan, GA 30265-1618
Phone (770) 253-1912

Hospital & facility affiliations

  • Piedmont Newnan Hospital, Inc Hospital, Newnan, GA, CCN 110229

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT197942PAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Regional Physicians Management Group, LLC CurrentSince Dec 17, 2018 Accepting new patients
Coweta Emergency Group LLC Emergency Medicine CurrentSince Jul 1, 2013 Accepting new patients
Angelfish Emergency Physicians, LLC Emergency Medicine CurrentSince Aug 1, 2021 Accepting new patients
Hahnemann University Hospital Emergency Medicine Past Accepting new patients

Locations

5126 Hospital Dr NE
Covington, GA 30014
Phone (770) 385-4340

745 Poplar Rd
Newnan, GA 30265
Phone (404) 478-8785

11 Upper Riverdale Rd SW
Riverdale, GA 30274
Phone (770) 897-7277

2160 Fountain Dr
Snellville, GA 30078
Phone (770) 982-1111

1700 Medical Way
Snellville, GA 30078
Phone (770) 978-4229

Organizations & group practices 4

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

Hospital & facility affiliations 1

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": "1346976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359936000000",
    "number": "1407105232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 N BROAD ST",
            "address_2": "APT 101",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191303420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 N BROAD ST",
            "address_2": "APT 101",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191303420",
            "telephone_number": "678-596-4621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHN",
        "first_name": "KORY",
        "middle_name": "GREGGS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-07",
        "last_updated": "2013-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MT197942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.