NPIMap

Organization Active NPI

Keller, Crymes, & Demarco LLC

  • Ophthalmology Physician
  • Athens, GA
National Provider Identifier
1467406983
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
KELLER, CRYMES, & DEMARCO LLC
Practice address
105 Trinity PL.
Athens, GA 30607-2112
Phone
(706) 549-9993
Fax
(706) 549-4047
NPI assigned
May 20, 2006
Last updated
Jun 14, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
KELLER, CRYMES, & DEMARCO LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

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

Authorized official

Name
Dr. Anthony L Demarco, MDNPI 1699728501
Title
Doctor
Phone
(706) 549-9993

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

105 Trinity PL.
Athens, GA 30607-2112

Mailing address

105 Trinity PL.
Athens, GA 30607-2112
Phone (706) 549-9993

Other identifiers 1

IdentifierTypeStateIssuer
300031703AMedicaidGA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address DIRECT@athenseyedoctorssurgeonsathensga.compulinkdirect.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040505000810 GA Part B Supplier - Clinic/Group Practice 3971591132 Receives reassigned benefits from 11 practitioners
Practice locations: Winder, GA; Washington, GA; Lavonia, GA; Madison, GA; Greensboro, GA; Athens, GA; Commerce, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Keller Crymes Demarco LL2 organizations share this tax ID, including this one
Part of
Keller Crymes Demarco LL

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

1115 S Elm St
Commerce, GA 30529
Phone (706) 335-5139

709 Elbert St
Ste B
Elberton, GA 30635

13375 Jones St
Ste B2
Lavonia, GA 30553
Phone (706) 356-0206

222 S Main St
Madison, GA 30650

279 N Broad St
Ste C
Winder, GA 30680
Phone (404) 867-2505

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623628800000",
    "number": "1467406983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 TRINITY PL.",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306072112",
            "telephone_number": "706-549-9993",
            "fax_number": "706-549-4047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 TRINITY PL.",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306072112",
            "telephone_number": "706-549-9993",
            "fax_number": "706-549-4047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLER, CRYMES, & DEMARCO LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KELLER, CRYMES, & DEMARCO LLC",
        "enumeration_date": "2006-05-20",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A",
        "authorized_official_last_name": "DEMARCO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "706-549-9993",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300031703A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DIRECT@athenseyedoctorssurgeonsathensga.compulinkdirect.com",
            "affiliation": "N",
            "endpointDescription": "CCD",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "105 Trinity Pl.",
            "city": "Athens",
            "state": "GA",
            "country_code": "US",
            "postal_code": "306072112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.