Tasia Fortune, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11303 Issued in GA

Practice address

4500 Hospital Blvd Ste 320
Roswell, GA 30076-0001

Phone

(770) 410-4520

Fax

(770) 410-4525

NPI assigned

Aug 15, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC, GA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellstar North Fulton Medical Center Hospital, Roswell, GA, CCN 110198

Merit-based Incentive Payment System (MIPS)

Final score

93.93 of 100Reported as apm

Quality

82.14

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment Care Compare group
• Apogee Medical Group South Carolina

  • Internal Medicine Physician
  • Scottsdale, AZ
  • NPI 1619028545

  SC

  Medicare reassignment
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Wellstar Medical Group, LLC

  • Surgery Physician
  • Austell, GA
  • NPI 1316230329
  NPD
• Wellstar Cardiovascular Medicine, LLC

  • Cardiovascular Disease Physician
  • Marietta, GA
  • NPI 1457320319
  NPD (past)
• Gardner-Webb University

  • Voluntary or Charitable Agency
  • Boiling Springs, NC
  • NPI 1720265903
  NPD (past)
• Gardner-Webb University

  • Voluntary or Charitable Agency
  • Boiling Springs, NC
  • NPI 1881870038
  NPD (past)

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

• Wellstar North Fulton Hospital, Inc

  • General Acute Care Hospital
  • Roswell, GA
  • NPI 1750312997
  Care Compare affiliation

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

{
    "created_epoch": "1565827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1861048787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 HOSPITAL BLVD STE 320",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300760001",
            "telephone_number": "770-410-4520",
            "fax_number": "770-410-4525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 HOSPITAL BLVD STE 320",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300760001",
            "telephone_number": "770-410-4520",
            "fax_number": "770-410-4525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8 Richland Medical Park Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292038008",
            "country_code": "US",
            "telephone_number": "803-434-3800",
            "fax_number": "803-744-2759",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "110 S Main St",
            "address_purpose": "LOCATION",
            "city": "Boiling Springs",
            "state": "NC",
            "postal_code": "280179797",
            "country_code": "US",
            "telephone_number": "704-406-2369",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORTUNE",
        "first_name": "TASIA",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-15",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "3607",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "11303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4455PA",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tfortune510845@directwellstar.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "4500 Hospital Blvd Ste 320",
            "city": "Roswell",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300760001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Form Pelvic Health LLC
• Form Physical Therapy LLC
• Forma Medical Aesthetics
• Paria Foroughi Arani, RBT
• Alexis Danielle Fortson
• Forward Strides Counseling LLC
• Dawn M Foster, ED.S., LMFT
• Denetrice Foster
• Jamie J. Foster, D.C.
• Melissa Foster

• Physician Assistant in Roswell, GA
• Providers in Roswell, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; 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.