Organization Active NPI

Medimprove Clinical LLC

  • Pulmonary Disease Physician
  • Atlanta, GA
National Provider Identifier
1548072580
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
MEDIMPROVE CLINICAL LLC
Practice address
371 E Paces Ferry Rd NE
Atlanta, GA 30305-2372
Phone
(646) 285-3174
NPI assigned
Jan 27, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Authorized official

Name
Jan De Backer
Title
Chief Administrative Officer
Phone
(646) 258-3174

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

371 E Paces Ferry Rd NE
Atlanta, GA 30305-2372

Mailing address

371 E Paces Ferry Rd NE
Atlanta, GA 30305-2372

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250514003960 GA Part B Supplier - Clinic/Group Practice 7719405638 Receives reassigned benefits from 2 practitioners
Practice locations: Atlanta, GA

National Provider Directory

National Provider Directory

Locations

371 E Paces Ferry Rd NE
Atlanta, GA 30305
Phone (404) 400-3120

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1737936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1548072580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "371 E PACES FERRY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303052372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "371 E PACES FERRY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303052372",
            "telephone_number": "646-285-3174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIMPROVE CLINICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-27",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "DE BACKER",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "646-258-3174"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; 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.