NPIMap

Organization Active NPI

Kaiser Foundation Health Plan of Georgia, Inc.

  • Managed Care Organization Pharmacy
  • Holly Springs, GA
National Provider Identifier
1881910552
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Managed Care Organization PharmacyTaxonomy code 3336M0003X
License
PHRE009659 Issued in GA
Legal business name
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Practice address
684 Sixes Rd Ste 275
Holly Springs, GA 30115-8721
Phone
(770) 852-2440
Fax
(770) 852-2441
NPI assigned
Apr 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Authorized official

Name
Ms. Diane Sanders
Title
Pharmacy Compliance Manager
Phone
(770) 712-5654

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Managed Care Organization Pharmacy 3336M0003X PHRE009659 GA Primary

Addresses

Primary practice location

684 Sixes Rd Ste 275
Holly Springs, GA 30115-8721

Mailing address

684 Sixes Rd Ste 275
Holly Springs, GA 30115-8721
Phone (770) 852-2440

Other identifiers 1

IdentifierTypeStateIssuer
1159715OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Kaiser Permanente Holly Springs Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Foundation Health67 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

Locations

684 Sixes Rd
Ste 275
Holly Springs, GA 30115
Phone (770) 852-2439

NPI Registry JSON

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

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1881910552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "684 SIXES RD STE 275",
            "city": "HOLLY SPRINGS",
            "state": "GA",
            "postal_code": "301158721",
            "telephone_number": "770-852-2440",
            "fax_number": "770-852-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "684 SIXES RD STE 275",
            "city": "HOLLY SPRINGS",
            "state": "GA",
            "postal_code": "301158721",
            "telephone_number": "770-852-2440",
            "fax_number": "770-852-2441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-20",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "PHARMACY COMPLIANCE MANAGER",
        "authorized_official_telephone_number": "770-712-5654",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": "GA",
            "license": "PHRE009659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1159715",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "684 Sixes Rd Ste 275",
            "city": "Holly Springs",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301158721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kaiser Permanente Holly Springs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kaiser Permanente Holly Springs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holly Springs, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.