NPIMap

Organization Active NPI

Independent Physical Therapy of Georgia, LLC

  • Physical Therapy Clinic/Center
  • Atlanta, GA
National Provider Identifier
1770837445
Registry record updated Nov 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC
Practice address
3885 Princeton Lakes Way SW Ste 408
Atlanta, GA 30331-5599
Phone
(404) 344-2823
Fax
(404) 629-3737
NPI assigned
Nov 2, 2012
Last updated
Nov 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2018

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

Authorized official

Name
Kevin Johanneson
Title
VP Revenue Cycle
Phone
(423) 238-7217

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Physical Therapy Clinic/Center 261QP2000X Primary
Rehabilitation Clinic/Center 261QR0400X
Occupational Medicine Clinic/Center 261QX0100X

Addresses

Primary practice location

3885 Princeton Lakes Way SW Ste 408
Atlanta, GA 30331-5599

Mailing address

6397 Lee Hwy Ste 300
Chattanooga, TN 37421-2564
Phone (423) 238-7217

Other practice location 1

3645 Marketplace Blvd Ste 160
East Point, GA 30344-5749
Phone (404) 662-2195

Other names 1

  • BenchMark Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040303000396 GA Part B Supplier - Clinic/Group Practice 2961312244 Receives reassigned benefits from 1,039 practitioners
35 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 35

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

View all 35

National Provider Directory

National Provider Directory

Locations

4959 Bill Gardner Pkwy
Ste 109
Locust Grove, GA 30248
Phone (770) 914-9285

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1351814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541462400000",
    "number": "1770837445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6397 LEE HWY STE 300",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374212564",
            "telephone_number": "423-238-7217",
            "fax_number": "423-238-3473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3885 PRINCETON LAKES WAY SW STE 408",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303315599",
            "telephone_number": "404-344-2823",
            "fax_number": "404-629-3737"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3645 Marketplace Blvd Ste 160",
            "address_purpose": "LOCATION",
            "city": "East Point",
            "state": "GA",
            "postal_code": "303445749",
            "country_code": "US",
            "telephone_number": "404-662-2195",
            "fax_number": "404-662-2369",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INDEPENDENT PHYSICAL THERAPY OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-02",
        "last_updated": "2018-11-06",
        "status": "A",
        "authorized_official_last_name": "JOHANNESON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP REVENUE CYCLE",
        "authorized_official_telephone_number": "423-238-7217"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BenchMark",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "BenchMark",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.