Jaeson K. Courseault

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

86941 Issued in GA

Practice address

3939 Lavista Rd
Ste. E274
Atlanta, GA 30345

Phone

(404) 500-7224

NPI assigned

May 31, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Family Practice

Education

Tulane University School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sports Medicine South of Gwinnett LLCGroup PAC ID 9335566967, 14 clinicians

Northside Surgical Professional Services LLCGroup PAC ID 8628253424, 367 clinicians

Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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

• Northside Surgical Professional Services LLC

  • Surgery Physician
  • Atlanta, GA
  • NPI 1356630990
  Medicare reassignment Care Compare group NPD
• Sports Medicine South of Gwinnett LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Lawrenceville, GA
  • NPI 1265053110
  Medicare reassignment Care Compare group NPD
• Hillcrest Physician Services

  • Internal Medicine Physician
  • Waco, TX
  • NPI 1649294323
  NPD
• Scott & White Hospital - Taylor

  • Emergency Medicine Physician
  • Taylor, TX
  • NPI 1659366557
  NPD (past)

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

• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Cumming, GA
  • NPI 1376574277
  Care Compare affiliation

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

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1609137140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2994 E RAMBLE LN",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300331120",
            "telephone_number": "404-500-7224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 LAVISTA RD",
            "address_2": "STE. E274",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30345",
            "telephone_number": "404-500-7224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COURSEAULT",
        "first_name": "JAESON",
        "middle_name": "K.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-31",
        "last_updated": "2021-09-13",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "TX",
            "license": "Q5992",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "GA",
            "license": "86941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Counseling Crisis and Caring, LLC
• Counseling for Change, LLC
• Counseling Services of Catherine McKendrick
• Courage and Motivation Psychotherapy and Coaching
• Courage of Love Counseling Center, LLC
• Debora Lou Coursey-Prah, MD
• Ansley Payton Coursey, NP
• Christie Ward Coursey, IBCLC
• Daniel Bryant Coursey, PA-C
• Alyssa Courshon, AA

• Sports Medicine (Family Medicine) Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Sports Medicine (Family Medicine) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.