Individual provider Active NPI

James E Gleason Jr., MD

  • Family Medicine Physician
  • Riverdale, GA
National Provider Identifier
1780649368
Registry record updated Jan 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
030466 Issued in GA
Practice address
33 Upper Riverdale Rd SW Ste 118
Riverdale, GA 30274-2642
Phone
(770) 994-6969
Fax
(888) 651-5324
NPI assigned
Apr 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 030466 GA Primary

Addresses

Primary practice location

33 Upper Riverdale Rd SW Ste 118
Riverdale, GA 30274-2642

Mailing address

PO Box 962466
Riverdale, GA 30296-6923
Phone (770) 994-6969

Other practice location 1

33 Upper Riverdale Rd SW Ste 118
Riverdale, GA 30274-2642
Phone (770) 994-6969

Other identifiers 1

IdentifierTypeStateIssuer
005739ZZDMedicaidGA

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
I20080429000156 GA Practitioner - Family Practice 0446338685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

33 Upper Riverdale Rd SW
Suite 118
Riverdale, GA 30274-2642
Phone (770) 994-6969

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
James E. Gleason Jr, MDPC Family Medicine CurrentSince Feb 11, 2008 Accepting new patients

Locations

7365 Old National Hwy
Riverdale, GA 30296
Phone (770) 991-6300

33 Upper Riverdale Rd SW
Ste 118
Riverdale, GA 30274
Phone (770) 991-8000

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1780649368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 962466",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302966923",
            "telephone_number": "770-994-6969",
            "fax_number": "888-651-5324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 UPPER RIVERDALE RD SW STE 118",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742642",
            "telephone_number": "770-994-6969",
            "fax_number": "888-651-5324"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "33 Upper Riverdale Rd SW Ste 118",
            "address_purpose": "LOCATION",
            "city": "Riverdale",
            "state": "GA",
            "postal_code": "302742642",
            "country_code": "US",
            "telephone_number": "770-994-6969",
            "fax_number": "888-651-5324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLEASON",
        "first_name": "JAMES",
        "middle_name": "E",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2024-01-16",
        "certification_date": "2022-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "030466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005739ZZD",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, GA

Sources for this page

Verify at the official NPI Registry.