Individual provider Active NPI

Thomeshia Latoy Cammon, PA-C

  • Physician Assistant
  • Cumming, GA
National Provider Identifier
1922259696
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5752 Issued in GA
Practice address
2000 Howard Farm Dr Ste 200
Cumming, GA 30041-6081
Phone
(770) 758-8964
Fax
(770) 292-6535
NPI assigned
Sep 30, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA1049 KY
Physician Assistant 363A00000X 5752 GA Primary

Addresses

Primary practice location

2000 Howard Farm Dr Ste 200
Cumming, GA 30041-6081

Mailing address

2000 Howard Farm Dr Ste 200
Cumming, GA 30041-6081
Phone (770) 758-8964

Other identifiers 1

IdentifierTypeStateIssuer
003121190AMedicaidGA

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101111000099 GA Practitioner - Physician Assistant 4587723325 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Joint Surgery Specialists, LLCGroup PAC ID 2961795190, 46 clinicians

Practice addresses (Care Compare)

2800 Buford Dr
Buford, GA 30519-5107
Phone (770) 292-6500

3400 A Old Milton Pkwy
Alpharetta, GA 30005-4438
Phone (770) 667-4343

771 Old Norcross Rd
Suite 135
Lawrenceville, GA 30046-4978
Phone (770) 292-6500

Merit-based Incentive Payment System (MIPS)

Final score
79.29 of 100Reported as group
Quality
67.84
Promoting interoperability
73
Improvement activities
40
Cost
85.62

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA1049KYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Surgical Professional Services LLC Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1922259696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HOWARD FARM DR STE 200",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300416081",
            "telephone_number": "770-758-8964",
            "fax_number": "770-292-6535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 HOWARD FARM DR STE 200",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300416081",
            "telephone_number": "770-758-8964",
            "fax_number": "770-292-6535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMMON",
        "first_name": "THOMESHIA",
        "middle_name": "LATOY",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-30",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA1049",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "5752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003121190A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.