Individual provider Active NPI

Zhuocheng Su, DO

  • Internal Medicine Physician
  • Dacula, GA
National Provider Identifier
1578057303
Registry record updated Jul 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
89005 Issued in GA
Practice address
2069 Teron Trce Ste 100
Dacula, GA 30019-1665
Phone
(678) 730-1620
Fax
(678) 730-0858
NPI assigned
Jun 15, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 89005 GA Primary
Internal Medicine Physician 207R00000X LL52025 SC

Addresses

Primary practice location

2069 Teron Trce Ste 100
Dacula, GA 30019-1665

Mailing address

2069 Teron Trce Ste 100
Dacula, GA 30019-1665
Phone (678) 730-1620

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210813001269 GA Practitioner - Internal Medicine 7315283603 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia Col of Osteo Med, Sewanee, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gwinnett Physician Group, LLCGroup PAC ID 9133211139, 112 clinicians
Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians

Practice addresses (Care Compare)

2069 Teron Trce
Suite 100
Dacula, GA 30019-1665
Phone (678) 730-1620

3605 Braselton Hwy
Suite 101
Dacula, GA 30019-4666
Phone (770) 904-0772

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
89005GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gwinnett Physician Group, LLC Internal Medicine CurrentSince Aug 1, 2021 Accepting new patients
Gwinnett Medical Group, Inc Internal Medicine Past Accepting new patients

Locations

2069 Teron Trce
Ste 100
Dacula, GA 30019
Phone (678) 730-1620

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1578057303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2069 TERON TRCE STE 100",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300191665",
            "telephone_number": "678-730-1620",
            "fax_number": "678-730-0858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2069 TERON TRCE STE 100",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300191665",
            "telephone_number": "678-730-1620",
            "fax_number": "678-730-0858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SU",
        "first_name": "ZHUOCHENG",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-15",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "89005",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "LL52025",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dacula, GA

Sources for this page

Verify at the official NPI Registry.