NPIMap

Organization Active NPI

Ponce Preventive Care LLC

  • Primary Care Clinic/Center
  • Decatur, GA
National Provider Identifier
1477865681
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
054263 Issued in GA
Legal business name
PONCE PREVENTIVE CARE LLC
Practice address
315 W Ponce de Leon Ave Ste 110
Decatur, GA 30030-2441
Phone
(404) 537-2521
Fax
(844) 246-7292
NPI assigned
Jul 6, 2010
Last updated
May 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2024

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

Authorized official

Name
Rosa Figueroa
Title
Practice Administrator
Phone
(404) 537-2521

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 054263 GA Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

315 W Ponce de Leon Ave Ste 110
Decatur, GA 30030-2441

Mailing address

315 W Ponce de Leon Ave Ste 110
Decatur, GA 30030-2441
Phone (404) 537-2521

Other names 1

  • Ponce Preventive Care LLC Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rosa.figueroa@ponceprimarycare.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
O20100706000463 GA Part B Supplier - Clinic/Group Practice 6406987544 Receives reassigned benefits from 16 practitioners
Practice locations: Decatur, GA

National Provider Directory

National Provider Directory

Locations

315 W Ponce de Leon Ave
Ste 110
Decatur, GA 30030
Phone (404) 371-9673

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1278374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714953600000",
    "number": "1477865681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 W PONCE DE LEON AVE STE 110",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300302441",
            "telephone_number": "404-537-2521",
            "fax_number": "844-246-7292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W PONCE DE LEON AVE STE 110",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300302441",
            "telephone_number": "404-537-2521",
            "fax_number": "844-246-7292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONCE PREVENTIVE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-06",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A",
        "authorized_official_last_name": "FIGUEROA",
        "authorized_official_first_name": "ROSA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "404-537-2521"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "054263",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rosa.figueroa@ponceprimarycare.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "315 W Ponce De Leon Ave Ste 110",
            "city": "Decatur",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300302441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Ponce Preventive Care LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Ponce Preventive Care LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; 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.