NPIMap

Organization Active NPI

Rosenthal, Clark and Matsurra

  • Specialist
  • Atlanta, GA
National Provider Identifier
1568670180
Registry record updated Aug 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
ROSENTHAL, CLARK AND MATSURRA
Practice address
315 Boulevard
N.E. 412
Atlanta, GA 30312-1264
Phone
(404) 524-0095
Fax
(404) 658-9558
NPI assigned
May 18, 2007
Last updated
Aug 26, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2011

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

Authorized official

Name
Mrs. Connie Dillard
Title
Practice Administrator
Phone
(404) 524-0095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

315 Boulevard
N.E. 412
Atlanta, GA 30312-1264

Mailing address

315 Boulevard NE
N.E. 412
Atlanta, GA 30312-1200
Phone (404) 524-0095

Other identifiers 1

IdentifierTypeStateIssuer
055001472AMedicaidGA

Other names 1

  • Atlanta Vascular Specialists Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060112000991 GA Part B Supplier - Clinic/Group Practice 8729001938 Receives reassigned benefits from 7 practitioners
Practice locations: Fayetteville, GA; Griffin, GA; Newnan, GA

National Provider Directory

National Provider Directory

Member organizations 1

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

Locations

315 Boulevard NE
Ste 412
Atlanta, GA 30312
Phone (404) 524-0095

2201 Newnan Crossing Blvd E
Ste 200
Newnan, GA 30265
Phone (404) 524-0095

2690 Highway 34 E
Ste A
Newnan, GA 30265
Phone (678) 423-4100

2690 Highway 34 E
Ste B
Newnan, GA 30265
Phone (404) 524-0095

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314316800000",
    "number": "1568670180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 BOULEVARD NE",
            "address_2": "N.E. 412",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303121200",
            "telephone_number": "404-524-0095",
            "fax_number": "404-658-9558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 BOULEVARD",
            "address_2": "N.E. 412",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303121264",
            "telephone_number": "404-524-0095",
            "fax_number": "404-658-9558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSENTHAL, CLARK AND MATSURRA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2011-08-26",
        "status": "A",
        "authorized_official_last_name": "DILLARD",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "404-524-0095",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "055001472A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlanta Vascular Specialists",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Aug 26, 2011; 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.