Individual provider Active NPI

Canon Tate Rooker, PA

  • Physician Assistant
  • Sandy Springs, GA
National Provider Identifier
1669130852
Registry record updated Dec 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1150 Hammond Dr Ste 400
Sandy Springs, GA 30328-8617
Phone
(404) 256-2633
NPI assigned
Dec 4, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1150 Hammond Dr Ste 400
Sandy Springs, GA 30328-8617

Mailing address

13153 Old Hickory Blvd Apt 822
Antioch, TN 37013-4984
Phone (912) 312-2319

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220325002070 GA Practitioner - Physician Assistant 5395130496 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Providers LLCGroup PAC ID 9830082825, 526 clinicians

Practice addresses (Care Compare)

1968 Peachtree NW Rd
Atlanta, GA 30309-1281
Phone (404) 605-5000

1968 Peachtree Rd NW
Atlanta, GA 30309-1281

1968 Peachtree Rd NW Atlanta
77 Building Suite 3110
Atlanta, GA 30309-1281
Phone (770) 605-4224

1984 Peachtree Rd NW
Suite 300
Atlanta, GA 30309-5219
Phone (404) 367-3210

2001 Peachtree Rd NE
Atlanta, GA 30309-1476

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Organizations & group practices 1

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.

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": "1638576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638576000000",
    "number": "1669130852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13153 OLD HICKORY BLVD APT 822",
            "city": "ANTIOCH",
            "state": "TN",
            "postal_code": "370134984",
            "telephone_number": "912-312-2319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 HAMMOND DR STE 400",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303288617",
            "telephone_number": "404-256-2633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROOKER",
        "first_name": "CANON",
        "middle_name": "TATE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-04",
        "last_updated": "2021-12-04",
        "certification_date": "2021-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy Springs, GA

Sources for this page

Verify at the official NPI Registry.