Gem Primary Healthcare, LLC.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

GEM PRIMARY HEALTHCARE, LLC.

Practice address

175 Country Club Dr BLDG 100D
Stockbridge, GA 30281-7380

Phone

(678) 819-5497

Fax

(678) 601-1508

NPI assigned

Sep 7, 2022

Organization subpart

No

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

Authorized official

Name

Geraldine Eccleston Menchion, FNP-BCNPI 1598403628

Title

NP

Phone

(404) 514-6066

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

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

• Geraldine Eccleston Menchion, FNP, BC

  • Family Nurse Practitioner
  • Stockbridge, GA
  • NPI 1598403628

  GA

  Medicare reassignment NPD Authorized official
• Kenneth F. Menchion, MD

  • Vascular Surgery Physician
  • Stockbridge, GA
  • NPI 1508822776
  NPD (past)

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

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677801600000",
    "number": "1457072647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 COUNTRY CLUB DR BLDG 100D",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817380",
            "telephone_number": "678-819-5497",
            "fax_number": "678-601-1508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 COUNTRY CLUB DR BLDG 100D",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817380",
            "telephone_number": "678-819-5497",
            "fax_number": "678-601-1508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEM PRIMARY HEALTHCARE, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-07",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A",
        "authorized_official_last_name": "MENCHION",
        "authorized_official_first_name": "GERALDINE",
        "authorized_official_middle_name": "ECCLESTON",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "404-514-6066",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Stockbridge, GA
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.