NPIMap

Organization Active NPI

Centerwell Senior Primary Care Ga PC

Doing business as CenterWell Senior Primary Care-Woodstock

  • Internal Medicine Physician
  • Woodstock, GA
National Provider Identifier
1689491680
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CENTERWELL SENIOR PRIMARY CARE GA PC
Doing business as
CenterWell Senior Primary Care-Woodstock
Practice address
6435 Bells Ferry Rd # 110
Woodstock, GA 30189-2317
Phone
(678) 941-6244
Fax
(770) 545-6597
NPI assigned
Sep 23, 2024
Last updated
Dec 17, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTERWELL SENIOR PRIMARY CARE GA PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Authorized official

Name
Angie Martinez
Title
Senior Credentialing Professional
Phone
(407) 447-7120

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X Primary
General Practice Physician 208D00000X

Addresses

Primary practice location

6435 Bells Ferry Rd # 110
Woodstock, GA 30189-2317

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (407) 447-7120

Other names 1

  • CenterWell Senior Primary Care-Woodstock Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210901004313 GA Part B Supplier - Clinic/Group Practice 3274939061 Receives reassigned benefits from 69 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Atlanta, GA; Woodstock, GA; Suwanee, GA; Stone Mountain, GA; South Fulton, GA; Savannah, GA; Morrow, GA; Marietta, GA…

Other NPIs on the same Medicare enrollment 12

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2326064Centerwell Senior Primary Care(Ga) PC-Woodstock6435 Bells Ferry Road, #110, Woodstock, GA 30189Certificate of waiverJun 25, 2027

National Provider Directory

National Provider Directory
Tax ID family
Centerwell Senior Primary Care Ga PC13 organizations share this tax ID, including this one
Part of
Centerwell Senior Primary Care Ga PC

Other organizations with this tax ID 12

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

Locations

3435 Wrightsboro Rd
Ste 1202
Augusta, GA 30909
Phone (706) 445-2349

3615 Charles Hardy Pkwy
#200
Dallas, GA 30157
Phone (678) 941-6247

6435 Bells Ferry Rd
#110
Woodstock, GA 30189
Phone (678) 941-6244

Practitioners & affiliated clinicians

Practitioners 87

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 87

NPI Registry JSON

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

{
    "created_epoch": "1727049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1689491680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "407-447-7120",
            "fax_number": "407-770-0661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6435 BELLS FERRY RD # 110",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301892317",
            "telephone_number": "678-941-6244",
            "fax_number": "770-545-6597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERWELL SENIOR PRIMARY CARE GA PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTERWELL SENIOR PRIMARY CARE GA PC",
        "enumeration_date": "2024-09-23",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "SENIOR CREDENTIALING PROFESSIONAL",
        "authorized_official_telephone_number": "407-447-7120"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CenterWell Senior Primary Care-Woodstock",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CenterWell Senior Primary Care-Woodstock",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodstock, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.