NPIMap

Organization Active NPI

To Our Shores, Inc

  • Primary Care Clinic/Center
  • Lawrenceville, GA
National Provider Identifier
1639749054
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
TO OUR SHORES, INC
Practice address
250 Langley Dr Ste 1101
Lawrenceville, GA 30046-6932
Phone
(770) 954-5997
NPI assigned
Jun 28, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Authorized official

Name
Dr. Miyesha Asatu Cheeks, DNP, MSN, FNP-BCNPI 1316005523
Title
Executive Director/FNP
Phone
(917) 853-5056

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

250 Langley Dr Ste 1101
Lawrenceville, GA 30046-6932

Mailing address

250 Langley Dr Ste 1101
Lawrenceville, GA 30046-6932
Phone (917) 853-5056

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220617000634 GA Part B Supplier - Clinic/Group Practice 0648657130 Receives reassigned benefits from 1 practitioner
Practice locations: Lawrenceville, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
To Our Shores Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

250 Langley Dr
Ste 1101
Lawrenceville, GA 30046
Phone (770) 954-5997

Practitioners & affiliated clinicians

Practitioners 2

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": "1624838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624924800000",
    "number": "1639749054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 LANGLEY DR STE 1101",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300466932",
            "telephone_number": "917-853-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 LANGLEY DR STE 1101",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300466932",
            "telephone_number": "770-954-5997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TO OUR SHORES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-28",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A",
        "authorized_official_last_name": "CHEEKS",
        "authorized_official_first_name": "MIYESHA",
        "authorized_official_middle_name": "ASATU",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/FNP",
        "authorized_official_telephone_number": "917-853-5056",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, MSN, FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; 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.