Heart of Georgia Primary Care, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

HEART OF GEORGIA PRIMARY CARE, LLC

Practice address

911 Plaza Ave Ste C
Eastman, GA 31023-6786

Phone

(478) 374-5774

NPI assigned

Jun 17, 2019

Organization subpart

No

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

Authorized official

Name

Ms. Amy H Cravey, FNP-C

Title

Owner

Phone

(478) 374-5774

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• Direct secure messaging: amy.cravey@mtpm.eclinicaldirectplus.com
• FHIR API: https://fhir4.healow.com/fhir/r4/AEADBA

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amy Harrell Banks, DNP, APRN, FNP-C

  • Nurse Practitioner
  • Eastman, GA
  • NPI 1225362932

  GA

  Medicare reassignment Care Compare group NPD
• Brianna Jessup Crummey, NP

  • Family Nurse Practitioner
  • Eastman, GA
  • NPI 1316509771

  Family, GA

  Medicare reassignment Care Compare group NPD
• Lucian Clement Moseley, MSN, FNP-C

  • Family Nurse Practitioner
  • Cochran, GA
  • NPI 1902504996

  Family, GA

  Medicare reassignment Care Compare group NPD
• Michael Todd Peacock, M.D.

  • Internal Medicine Physician
  • Eastman, GA
  • NPI 1487636742

  GA

  Medicare reassignment Care Compare group NPD
• Deananne D Fordham, PAC

  • Medical Physician Assistant
  • Cochran, GA
  • NPI 1215904446

  GA

  Medicare reassignment

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

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1780244301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 PLAZA AVE STE C",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236786",
            "telephone_number": "478-374-5774",
            "fax_number": "912-374-9112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 PLAZA AVE STE C",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236786",
            "telephone_number": "478-374-5774"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "706 W Barnard St",
            "address_purpose": "LOCATION",
            "city": "Glennville",
            "state": "GA",
            "postal_code": "304273017",
            "country_code": "US",
            "telephone_number": "912-822-1941",
            "fax_number": "912-822-1945",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "150 E Peacock St Ste A",
            "address_purpose": "LOCATION",
            "city": "Cochran",
            "state": "GA",
            "postal_code": "310147847",
            "country_code": "US",
            "telephone_number": "478-271-3200",
            "fax_number": "478-271-3205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HEART OF GEORGIA PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-17",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A",
        "authorized_official_last_name": "CRAVEY",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-374-5774",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "296546508F",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE PROVIDER NUMBER",
            "identifier": "CS2005900319",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amy.cravey@mtpm.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Messaging",
            "address_1": "706 W Barnard St",
            "city": "Glennville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "304273017",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amy.cravey@mtpm.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Messaging",
            "address_1": "911 Plaza Ave Ste C",
            "city": "Eastman",
            "state": "GA",
            "country_code": "US",
            "postal_code": "310236786",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amy.cravey@mtpmeclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Messaging",
            "address_1": "150 E Peacock St Ste A",
            "city": "Cochran",
            "state": "GA",
            "country_code": "US",
            "postal_code": "310147847",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• All providers in Eastman, GA
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; 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.