NPIMap

Organization Active NPI

Kaiser Foundation Health Plan of Georgia, Inc.

Doing business as Kaiser Permanente Panola

  • Managed Care Organization Pharmacy
  • Lithonia, GA
National Provider Identifier
1487769378
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Managed Care Organization PharmacyTaxonomy code 3336M0003X
License
PHRE007143 Issued in GA
Legal business name
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Doing business as
Kaiser Permanente Panola
Practice address
5440 Hillandale Dr
Lithonia, GA 30058-4865
Phone
(770) 322-2737
Fax
(770) 322-3283
NPI assigned
Aug 20, 2006
Last updated
Aug 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Authorized official

Name
Ms. Diane SandersNPI 1811848682
Title
Phcy Compliance MGR
Phone
(770) 712-5654

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Managed Care Organization Pharmacy 3336M0003X PHRE007143 GA Primary

Addresses

Primary practice location

5440 Hillandale Dr
Lithonia, GA 30058-4865

Mailing address

5440 Hillandale Dr
Lithonia, GA 30058-4865
Phone (770) 322-2737

Other names 1

  • KAISER PERMANENTE PANOLA Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Foundation HLTH67 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

5440 Hillandale Dr
Lithonia, GA 30058
Phone (770) 322-2716

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1487769378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5440 HILLANDALE DR",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300584865",
            "telephone_number": "770-322-2737",
            "fax_number": "770-322-3283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5440 HILLANDALE DR",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300584865",
            "telephone_number": "770-322-2737",
            "fax_number": "770-322-3283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "PHCY COMPLIANCE MGR",
        "authorized_official_telephone_number": "770-712-5654",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": "GA",
            "license": "PHRE007143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5440 Hillandale Dr",
            "city": "Lithonia",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300584865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "KAISER PERMANENTE PANOLA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KAISER PERMANENTE PANOLA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lithonia, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.