NPIMap

Individual provider Active NPI

Kevin H Peacock, MD

  • Hematology & Oncology Physician
  • Conyers, GA
National Provider Identifier
1679686661
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
064241 Issued in GA
Practice address
1501 Milstead Rd NE
Suite 110
Conyers, GA 30012-3838
Phone
(770) 760-9949
Fax
(770) 760-9951
NPI assigned
Aug 16, 2006
Last updated
Mar 9, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology (Internal Medicine) Physician 207RH0000X 2004-00941 NC
Hematology & Oncology Physician 207RH0003X 064241 GA Primary
Medical Oncology Physician 207RX0202X 200400941 NC

Addresses

Primary practice location

1501 Milstead Rd NE
Suite 110
Conyers, GA 30012-3838

Mailing address

1835 Savoy Dr
Suite 300
Atlanta, GA 30341-1072
Phone (770) 495-3396

Other identifiers 9

IdentifierTypeStateIssuer
199212OtherNCMEDCOST
7119766OtherNCAETNA
145JCOtherNCBCBS
1679686661MedicaidVA
3810009045MedicaidWV
5905021MedicaidNC
119857791AMedicaidGA
808364OtherNCPARTNERS
Q0094FMedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kevin.peacockmd.p2@direct.gmg.nextgenshare.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101021000526 GA Practitioner - Hematology/OncologyPractitioner - Internal Medicine 2163474347 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
Virginia Commonwealth University, School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Atlanta Oncology Services LLCGroup PAC ID 1850627423, 29 clinicians

Practice addresses (Care Compare)

2098 Teron Trce
Suite 400
Dacula, GA 30019-1664
Phone (678) 722-3940

2800 Buford Dr
Suite 300
Buford, GA 30519-5107
Phone (770) 417-4336

631 Professional Dr
Suite 450
Lawrenceville, GA 30046-3370
Phone (770) 963-8030

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2004-00941NCMDHematology (Internal Medicine) Physician
064241GAMDHematology & Oncology Physician
200400941NCMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gwinnett Pathology Assoc PC Current Accepting new patients
Suburban Hematology Oncology Associates, PC Hematology & Oncology CurrentSince Apr 1, 2012 Accepting new patients
Gwinnett Physician Group, LLC CurrentSince Jul 8, 2012 Accepting new patients
Gwinnett Medical Group, Inc Current Accepting new patients
Northside Hospital, Inc. CurrentSince Jul 1, 2012 Accepting new patients
North Atlanta Oncology Services LLC Medical Oncology CurrentSince Jul 1, 2019 Accepting new patients
Northside Hospital, Inc. CurrentSince Jul 1, 2012 Accepting new patients
WRMC Hospital Operating Corporation Past Accepting new patients
Georgia Cancer Specialists I, PC Past Accepting new patients

Locations

2098 Teron Trce
Ste 400
Dacula, GA 30019
Phone (678) 312-6800

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

631 Professional Dr
Ste 450
Lawrenceville, GA 30046
Phone (770) 963-8030

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

Interoperability endpoints

  • Direct secure messaging: kevin.peacockmd.p2@direct.gmg.nextgenshare.com

Organizations & group practices 9

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 4

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": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1679686661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 SAVOY DR",
            "address_2": "SUITE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303411072",
            "telephone_number": "770-495-3396",
            "fax_number": "770-495-2307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 MILSTEAD RD NE",
            "address_2": "SUITE 110",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123838",
            "telephone_number": "770-760-9949",
            "fax_number": "770-760-9951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "KEVIN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology",
            "state": "NC",
            "license": "2004-00941",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "GA",
            "license": "064241",
            "primary": true
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "NC",
            "license": "200400941",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "199212",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7119766",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "145JC",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679686661",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810009045",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5905021",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119857791A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "808364",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q0094F",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kevin.peacockmd.p2@direct.gmg.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "direct messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "direct edge",
            "address_1": "1501 Milstead Rd NE",
            "address_2": "Suite 110",
            "city": "Conyers",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300123838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

Verify at the official NPI Registry.