NPIMap

Organization Active NPI

Grady Memorial Hospital Corporation

  • Multi-Specialty Clinic/Center
  • Atlanta, GA
National Provider Identifier
1649765686
Registry record updated Jun 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
GRADY MEMORIAL HOSPITAL CORPORATION
Practice address
3896 Princeton Lakes Way
Atlanta, GA 30331
Phone
(404) 616-8880
NPI assigned
Jun 22, 2018
Last updated
Jun 22, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
GRADY MEMORIAL HOSPITAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 22, 2018

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

Authorized official

Name
Tamara Anne Nilmeier
Title
Director of Revenue Cycle
Phone
(404) 616-8880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

3896 Princeton Lakes Way
Atlanta, GA 30331

Mailing address

80 Jesse Hill Jr Dr SE # 26042
Atlanta, GA 30303-3031
Phone (404) 616-8880

Other identifiers 1

IdentifierTypeStateIssuer
060-641OtherGABUSINESS PERMIT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100723000311 GA Part B Supplier - Clinic/Group Practice 7517032998 Receives reassigned benefits from 818 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Atlanta, GA; Chamblee, GA; College Park, GA; Decatur, GA; East Point, GA; Sandy Springs, GA; Union City, GA
O20181107003377 GA Part B Supplier - Clinic/Group Practice 7517032998 Receives reassigned benefits from 49 practitioners
Practice locations: Atlanta, GA

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Grady Health System

Member organizations 1

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

Locations

80 Jesse Hill Jr Dr SE
#26019
Atlanta, GA 30303
Phone (404) 616-2219

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Crestview Health & Rehabilitation CenterAtlanta, GA, CCN 115525 Skilled nursing facility Operational/Managerial Control Apr 22, 2008

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 92

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 92

NPI Registry JSON

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

{
    "created_epoch": "1529625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529625600000",
    "number": "1649765686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 JESSE HILL JR DR SE # 26042",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303033031",
            "telephone_number": "404-616-8880",
            "fax_number": "404-489-6920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3896 PRINCETON LAKES WAY",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30331",
            "telephone_number": "404-616-8880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRADY MEMORIAL HOSPITAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRADY MEMORIAL HOSPITAL CORPORATION",
        "enumeration_date": "2018-06-22",
        "last_updated": "2018-06-22",
        "status": "A",
        "authorized_official_last_name": "NILMEIER",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "404-616-8880"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS PERMIT",
            "identifier": "060-641",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.