Active NPI
Juan Bloodworth
- Family Nurse Practitioner
- Fort Oglethorpe, GA
National Provider Identifier
1841034600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- RN149334
- Practice address
- 2009 Old Lafayette Rd
Fort Oglethorpe, GA 30742-3510 - Phone
- (706) 956-2665
- NPI assigned
- Jun 25, 2024
- Last updated
- Jun 25, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN149334 | GA | Primary |
Addresses
Primary practice location
2009 Old Lafayette Rd
Fort Oglethorpe, GA 30742-3510
Mailing address
13570 N Main St
Trenton, GA 30752-2012
Phone (706) 956-2665
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: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241219000875 | GA | Order and Referring Only - Nurse Practitioner | 9638606346 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719273600000",
"number": "1841034600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13570 N MAIN ST",
"city": "TRENTON",
"state": "GA",
"postal_code": "307522012",
"telephone_number": "706-956-2665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2009 OLD LAFAYETTE RD",
"city": "FORT OGLETHORPE",
"state": "GA",
"postal_code": "307423510",
"telephone_number": "706-956-2665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOODWORTH",
"first_name": "JUAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-06-25",
"last_updated": "2024-06-25",
"certification_date": "2024-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "RN149334",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Oglethorpe, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.