NPIMap

Organization Active NPI

Macon Medical Group PC

  • Nephrology Physician
  • Macon, GA
National Provider Identifier
1912914847
Registry record updated May 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
MACON MEDICAL GROUP PC
Practice address
640 Martin Luther King Jr Blvd
Suite 200
Macon, GA 31201-3206
Phone
(478) 745-5455
Fax
(478) 745-2915
NPI assigned
Aug 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2009

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

Authorized official

Name
Ludwig V. Cavaliere, MD
Title
Physician/Co-Owner
Phone
(478) 745-5455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

640 Martin Luther King Jr Blvd
Suite 200
Macon, GA 31201-3206

Mailing address

640 Martin Luther King Jr Blvd
Suite 200
Macon, GA 31201-3206
Phone (478) 745-5455

Other identifiers 3

IdentifierTypeStateIssuer
CB5310OtherRXR MEDICARE
300025393HMedicaidGA
300025393DMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040505000790 GA Part B Supplier - Clinic/Group Practice 3173511334 Receives reassigned benefits from 12 practitioners
Practice locations: Macon, GA; Warner Robins, GA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0264059Macon Medical Group PC640 Martin Luther King Junior Boulevard Suite 200, Macon, GA 31201AccreditationMay 18, 2028

National Provider Directory

National Provider Directory

Locations

640 Martin Luther King Jr Blvd
Macon, GA 31201
Phone (478) 742-5850

309 Osigian Blvd
Warner Robins, GA 31088
Phone (478) 745-5455

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241395200000",
    "number": "1912914847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 MARTIN LUTHER KING JR BLVD",
            "address_2": "SUITE 200",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312013206",
            "telephone_number": "478-745-5455",
            "fax_number": "478-745-2915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 MARTIN LUTHER KING JR BLVD",
            "address_2": "SUITE 200",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312013206",
            "telephone_number": "478-745-5455",
            "fax_number": "478-745-2915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACON MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2009-05-04",
        "status": "A",
        "authorized_official_last_name": "CAVALIERE",
        "authorized_official_first_name": "LUDWIG",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "PHYSICIAN/CO-OWNER",
        "authorized_official_telephone_number": "478-745-5455",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RXR MEDICARE",
            "identifier": "CB5310",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300025393H",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300025393D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.