Kennestone Family Medicine

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

RN205404 Issued in GA

Legal business name

KENNESTONE FAMILY MEDICINE

Practice address

72 Plaza Way NW
Marietta, GA 30060-1104

Phone

(770) 795-8070

NPI assigned

Feb 20, 2017

Last updated

Feb 20, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sam PengNPI 1841221769

Title

MD

Phone

(770) 820-3855

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Kennestone Family Medicine2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Sam Peng MD PC

  • Geriatric Medicine (Family Medicine) Physician
  • Atlanta, GA
  • NPI 1043442080
  NPD tax ID

Interoperability endpoints

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sam Qingshuang Peng, M.D.

  • Family Medicine Physician
  • Marietta, GA
  • NPI 1841221769
  NPD (past) Authorized official

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

{
    "created_epoch": "1487548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1891234118",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 PLAZA WAY NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601104",
            "telephone_number": "770-795-8070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNESTONE FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-20",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "PENG",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "770-820-3855"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "RN205404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Love Kennedy, DMD
• Kennesaw Mountain Clinc Inc
• Kennestone Dental Care Center PC (Dental Care Center at Kennestone)
• Kennestone Dental Designs, LLC
• Kennestone Dentist LLC
• Kennestone Heart Physicians Group
• Kennestone Heart Physicians Group, PC
• Kennestone Heart Physicians Group, PC
• Kennestone Hospital Inc (WellStar Pharmacy Network)
• Kennestone Hospital Inc (WellStar Pharmacy Network)

• Primary Care Clinic/Center in Marietta, GA
• Providers in Marietta, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.