Individual provider Active NPI

Tondra Ivey, NP-C

  • Family Nurse Practitioner
  • Carrollton, GA
National Provider Identifier
1689100042
Registry record updated Oct 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN215166 Issued in GA
Practice address
129 Bankhead Hwy
Carrollton, GA 30117-3425
Phone
(770) 778-7456
NPI assigned
May 4, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN215166 GA Primary

Addresses

Primary practice location

129 Bankhead Hwy
Carrollton, GA 30117-3425

Mailing address

129 Bankhead Hwy
Carrollton, GA 30117-3425
Phone (770) 778-7456

Other identifiers 1

IdentifierTypeStateIssuer
003205171AMedicaidGA

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
I20180720002834 GA Practitioner - Nurse Practitioner 0648527697 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lagrange Emergency Physicians, LLCGroup PAC ID 0840207072, 20 clinicians

Practice addresses (Care Compare)

1514 Vernon Rd
Lagrange, GA 30240-4131
Phone (706) 882-1411

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
City of Hope Medical Group of Georgia LLC CurrentSince Jun 5, 2018 Accepting new patients
Lagrange Emergency Physicians, LLC CurrentSince Feb 20, 2021 Accepting new patients

Locations

1514 Vernon Rd
Lagrange, GA 30240
Phone (706) 812-2369

600 Celebrate Life Pkwy
Newnan, GA 30265
Phone (404) 844-8334

62742 Collections Ctr Dr
Chicago, IL 60693

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1493856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539216000000",
    "number": "1689100042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 BANKHEAD HWY",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173425",
            "telephone_number": "770-778-7456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 BANKHEAD HWY",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173425",
            "telephone_number": "770-778-7456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVEY",
        "first_name": "TONDRA",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-04",
        "last_updated": "2018-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN215166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003205171A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.