Sam Qingshuang Peng, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

057232 Issued in GA

Practice address

72 Plaza Way NW Ste 121
Marietta, GA 30060-1104

Phone

(770) 795-8070

Fax

(770) 795-8078

NPI assigned

Jul 6, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Family PracticeAlso: Geriatric Medicine

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellstar Home Health, LLC Home health agency, Marietta, GA, CCN 117102
• Enhabit Home Health Home health agency, Kennesaw, GA, CCN 117149
• Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035
• Wellstar Windy Hill Hospital Long-term care hospital, Marietta, GA, CCN 112007

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FAJDBA
• FHIR API: https://fhir4.healow.com/fhir/r4/FAJDBA/Endpoint/FAJDBA

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.

• Sam Peng MD PC

  • Geriatric Medicine (Family Medicine) Physician
  • Atlanta, GA
  • NPI 1043442080
  Medicare reassignment NPD Authorized official
• Kennestone Family Medicine

  • Primary Care Clinic/Center
  • Marietta, GA
  • NPI 1891234118
  NPD (past) Authorized official

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

• Caresouth HHA Holdings of Gainesville, LLC

  • Home Health Agency
  • Kennesaw, GA
  • NPI 1720435829
  Care Compare affiliation
• Kennestone Hospital, Inc.

  • General Acute Care Hospital
  • Marietta, GA
  • NPI 1649248626
  Care Compare affiliation
• Kennestone Hospital, Inc.

  • Long Term Care Hospital
  • Marietta, GA
  • NPI 1700853041

  Long-term care hospital

  Care Compare affiliation
• Wellstar Home Health, LLC

  • Home Health Agency
  • Marietta, GA
  • NPI 1073591376
  Care Compare affiliation

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613779200000",
    "number": "1841221769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 PLAZA WAY NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601104",
            "telephone_number": "770-795-8070",
            "fax_number": "770-795-8078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 PLAZA WAY NW STE 121",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601104",
            "telephone_number": "770-795-8070",
            "fax_number": "770-795-8078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENG",
        "first_name": "SAM",
        "middle_name": "QINGSHUANG",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2021-02-20",
        "certification_date": "2021-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "057232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Y Pellerito, PA
• Gordon J Peltier, MD
• Jeffrey Carl Pence, MD
• Rae K. Pencek, OTR/L
• Denis Pendrick
• Yin Peng
• Denise Pennington, SLP
• Joseph Scott Pennington, LPC
• Scott David Pennington, D.O.
• Matthew Penoyar, LMT

• Family Medicine Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2021; 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.
• 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.