Individual provider Active NPI

Marcus Cromer, MD

  • Family Medicine Physician
  • Athens, GA
National Provider Identifier
1417939182
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
P54480 Issued in GA
Practice address
1500 Oglethorpe Ave Ste 3300
Athens, GA 30606-2190
Phone
(800) 532-6151
Fax
(706) 354-5769
NPI assigned
Nov 17, 2005
Last updated
Aug 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X P54480 GA Primary

Addresses

Primary practice location

1500 Oglethorpe Ave Ste 3300
Athens, GA 30606-2190

Mailing address

1500 Oglethorpe Ave Ste 3300
Athens, GA 30606-2190
Phone (706) 208-1406

Other identifiers 2

IdentifierTypeStateIssuer
063483775AMedicaidGA
P00173058OtherGARAILROAD MEDICARE

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
I20040803000757 GA Practitioner - General PracticePractitioner - Emergency Medicine 7719958818 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Medical College of Georgia School of Medicine, 2001
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Dewitt and Chisolm, LLCGroup PAC ID 7517967318, 2 clinicians

Practice addresses (Care Compare)

1500 Oglethorpe Ave
Suite 3300
Athens, GA 30606-2190
Phone (706) 208-1406

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P54480GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dewitt and Chisolm, LLC Family Medicine CurrentSince Jun 12, 2024 Accepting new patients
Georgia Emergency Medicine Specialists, PC Emergency Medicine CurrentSince Aug 2, 2004 Accepting new patients

Locations

1199 Prince Ave
Athens, GA 30606
Phone (706) 354-3520

1500 Oglethorpe Ave
Ste 3300
Athens, GA 30606
Phone (706) 208-1406

Organizations & group practices 2

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 3

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": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1417939182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 OGLETHORPE AVE STE 3300",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062190",
            "telephone_number": "706-208-1406",
            "fax_number": "706-208-1407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 OGLETHORPE AVE STE 3300",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062190",
            "telephone_number": "800-532-6151",
            "fax_number": "706-354-5769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROMER",
        "first_name": "MARCUS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "P54480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "063483775A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00173058",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

Verify at the official NPI Registry.