Individual provider Active NPI

Kentrez Gerrod Thompson, MD

  • Family Medicine Physician
  • Athens, GA
National Provider Identifier
1770100398
Registry record updated Aug 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
100753 Issued in GA
Practice address
485 Highway 29 N
Athens, GA 30601-5583
Phone
(706) 438-4080
NPI assigned
Jun 30, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 84676 SC
Family Medicine Physician 207Q00000X 100753 GA Primary

Addresses

Primary practice location

485 Highway 29 N
Athens, GA 30601-5583

Mailing address

169 Ashley Avenue
Room 202 Main Hospital, MSC 333
Charleston, SC 29425

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240927002401 GA Practitioner - Family Practice 9335568948 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical University of South Carolina College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstreet of Georgia PCGroup PAC ID 7517126279, 425 clinicians

Practice addresses (Care Compare)

1034 Old Peachtree Rd NW
Lawrenceville, GA 30043-3308
Phone (678) 335-5400

13081 Hwy 9 N
Alpharetta, GA 30004-5150
Phone (770) 521-6690

2292 Peachtree Rd
Atlanta, GA 30309-1147
Phone (404) 382-9941

2701 Holcomb Bridge Rd
Alpharetta, GA 30022-6812
Phone (770) 998-7611

5438 Peachtree Blvd
Chamblee, GA 30341-2232
Phone (470) 816-0988

6660 Roswell Nerd
Sandy Springs, GA 30328-3167
Phone (404) 996-0195

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
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
84676SCMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstreet of Georgia PC CurrentSince Aug 5, 2024 Accepting new patients

Locations

485 Highway 29 N
Athens, GA 30601
Phone (706) 353-6000

2292 Peachtree Rd NW
Atlanta, GA 30309
Phone (404) 382-9941

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.

NPI Registry JSON

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

{
    "created_epoch": "1593475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1770100398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVENUE",
            "address_2": "ROOM 202 MAIN HOSPITAL, MSC 333",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "485 HIGHWAY 29 N",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306015583",
            "telephone_number": "706-438-4080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "KENTREZ",
        "middle_name": "GERROD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-30",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "84676",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "100753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

Verify at the official NPI Registry.