Active NPI
Raymond L Stovall, M.D.
- Internal Medicine Physician
- Lawrenceville, GA
National Provider Identifier
1861402695
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 025291
- Practice address
- 600 Professional Dr
Suite 150
Lawrenceville, GA 30046-8717 - Phone
- (678) 376-1800
- Fax
- (678) 376-5500
- NPI assigned
- Aug 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 025291 | GA | Primary |
Addresses
Primary practice location
600 Professional Dr
Suite 150
Lawrenceville, GA 30046-8717
Mailing address
600 Professional Dr
Suite 150
Lawrenceville, GA 30046-8717
Phone (678) 376-1800
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4031478 | Other | GA | AETNA |
| 743055533 | Other | GA | UNITED HEATLHCARE |
| 743055533 | Other | GA | BEECHSTREET |
| 00282675B | Medicaid | GA | |
| 743055533 | Other | GA | CAPP CARE |
| 743055533 | Other | GA | LST HEALTH |
| 182686 | Other | GA | COVENTRY |
| 52450038 | Other | GA | BLUE CROSS |
| 743055533 | Other | GA | PHCS |
| 743055533 | Other | GA | 743055533 |
| 10659984294 | Other | GA | HUMANA |
| 743055533 | Other | GA | HEALTHSTAR |
| 743055533 | Other | GA | ONE HEALTH |
| 743055533 | Other | GA | CCN |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100202000003 | GA | Practitioner - Internal Medicine | 7416949060 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thomas Lifetime Health LLC | Past | Accepting new patients |
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.
-
- Family Medicine Physician
- Lawrenceville, GA
- NPI 1265137822
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260835200000",
"number": "1861402695",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 PROFESSIONAL DR",
"address_2": "SUITE 150",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300468717",
"telephone_number": "678-376-1800",
"fax_number": "678-376-5500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 PROFESSIONAL DR",
"address_2": "SUITE 150",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300468717",
"telephone_number": "678-376-1800",
"fax_number": "678-376-5500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOVALL",
"first_name": "RAYMOND",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-08",
"last_updated": "2009-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "025291",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4031478",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEATLHCARE",
"identifier": "743055533",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEECHSTREET",
"identifier": "743055533",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00282675B",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPP CARE",
"identifier": "743055533",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LST HEALTH",
"identifier": "743055533",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COVENTRY",
"identifier": "182686",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "52450038",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS",
"identifier": "743055533",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "743055533",
"identifier": "743055533",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "10659984294",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHSTAR",
"identifier": "743055533",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ONE HEALTH",
"identifier": "743055533",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CCN",
"identifier": "743055533",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2009; 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.