NPIMap

Individual provider Active NPI

Marco Hallerbach, M.D.

  • Internal Medicine Physician
  • Lagrange, GA
National Provider Identifier
1447466446
Registry record updated Apr 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
066499 Issued in GA
Practice address
1514 Vernon Rd
Lagrange, GA 30240-4131
Phone
(706) 882-1411
NPI assigned
May 15, 2007
Last updated
Apr 14, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME103776 FL
Internal Medicine Physician 207R00000X 066499 GA Primary

Addresses

Primary practice location

1514 Vernon Rd
Lagrange, GA 30240-4131

Mailing address

1514 Vernon Rd
Lagrange, GA 30240-4131
Phone (706) 882-1411

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
I20130405000258 GA Practitioner - HospitalistPractitioner - Internal Medicine 8921151713 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southland Hospitalist Group, LLCGroup PAC ID 8022272913, 22 clinicians

Practice addresses (Care Compare)

915 Gordon Ave
Thomasville, GA 31792-6614
Phone (229) 228-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
066499GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southland Hospitalist Group, LLC CurrentSince Mar 1, 2014 Accepting new patients
Tift Regional Health System Inc CurrentSince May 3, 2016 Accepting new patients
Apogee Medical Group Georgia Inc Internal Medicine CurrentSince Jul 1, 2021 Accepting new patients
24 On Physicians, P.C. CurrentSince Apr 15, 2014 Accepting new patients
Tift Regional Health System Inc CurrentSince May 3, 2016 Accepting new patients
24 On Physicians, PC CurrentSince Apr 15, 2014 Accepting new patients
Mobile Physician Services Inc. Internal Medicine Past Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
John D Archbold Memorial Hospital Inc Past Accepting new patients
South Lake Hospital Inc Past Accepting new patients
South Lake Hospital, Inc. Past Accepting new patients

Locations

15059 N Scottsdale Rd
Ste 600
Scottsdale, AZ 85254
Phone (602) 778-3601

13000 Deerfield Pkwy
Ste 100
Alpharetta, GA 30004

1412 Milstead Ave NE
Conyers, GA 30012
Phone (770) 918-3000

304 Turner McCall Blvd SW
Rome, GA 30165
Phone (706) 506-5000

915 Gordon Ave
Thomasville, GA 31792
Phone (229) 228-8575

2225 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-3422

2501 N Patterson St
Valdosta, GA 31602
Phone (229) 259-4139

Organizations & group practices 11

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 5

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": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460592000000",
    "number": "1447466446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 VERNON RD",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404131",
            "telephone_number": "706-882-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 VERNON RD",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404131",
            "telephone_number": "706-882-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLERBACH",
        "first_name": "MARCO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-15",
        "last_updated": "2016-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME103776",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "066499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrange, GA

Sources for this page

Verify at the official NPI Registry.