Miriam P Gwathney, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

063343 Issued in GA

Practice address

1057 Main St
Forest Park, GA 30297-1482

Phone

(404) 301-4555

Fax

(404) 301-4482

NPI assigned

Jun 10, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA, TX2 enrollments

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 2

Specialty

Family Practice

Education

Philadelphia College of Osteopathic Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

DHHS,PHS,Naihs, Gallup Indian Medical CenterGroup PAC ID 3173436409, 179 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Gallup Indian Medical Center Hospital, Gallup, NM, CCN 320061

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

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

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.

• DHHS,PHS,Naihs, Gallup Indian Medical Center

  • General Acute Care Hospital
  • Gallup, NM
  • NPI 1225002322

  TX

  Medicare reassignment Care Compare group NPD
• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956

  Family Medicine

  Medicare reassignment NPD
• PMR Georgia Holding, LLC

  • Specialist
  • Miami Gardens, FL
  • NPI 1609329630

  GA

  Medicare reassignment NPD
• East Georgia Healthcare Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Reidsville, GA
  • NPI 1093754905
  NPD
• PMR Georgia Holding, LLC

  • Non-Pharmacy Dispensing Site
  • Forest Park, GA
  • NPI 1164194858
  NPD
• DHHS, PHS, Naihs, Gallup Indian Medical Center

  • Federal Public Health Clinic/Center
  • Tohatchi, NM
  • NPI 1902875594
  NPD
• Jencare Neighborhood Medical Center West End, LLC

  • Specialist
  • Atlanta, GA
  • NPI 1366783524
  NPD (past)
• Florida Department of Health

  • Public Health or Welfare Agency
  • Quincy, FL
  • NPI 1346446895
  NPD (past)

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682985600000",
    "number": "1881698546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 MAIN ST",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302971482",
            "telephone_number": "404-301-4555",
            "fax_number": "404-301-4482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1057 MAIN ST",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302971482",
            "telephone_number": "404-301-4555",
            "fax_number": "404-301-4482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWATHNEY",
        "first_name": "MIRIAM",
        "middle_name": "P",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-10",
        "last_updated": "2023-05-02",
        "certification_date": "2023-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "OS8157",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "063343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261406500",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "101 Banks Sta",
            "city": "Fayetteville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302147507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Medicine Physician in Forest Park, GA
• Providers in Forest Park, 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 May 2, 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.