NPIMap

Individual provider Active NPI

Joseph Jellicorse, M.D.

  • Family Medicine Physician
  • Carrollton, GA
National Provider Identifier
1932190535
Registry record updated Sep 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
046974 Issued in GA
Practice address
100 Professional Park
Suite 204
Carrollton, GA 30117-3874
Phone
(770) 834-3351
NPI assigned
Nov 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 046974 GA Primary

Addresses

Primary practice location

100 Professional Park
Suite 204
Carrollton, GA 30117-3874

Mailing address

100 Professional Park
Suite 204
Carrollton, GA 30117-3874
Phone (770) 834-3351

Other identifiers 3

IdentifierTypeStateIssuer
00823028AMedicaidGA
080157122OtherGARAIL ROAD MEDICARE
728652OtherGABLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100329000032 GA Practitioner - Family Practice 7810095296 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
East Tennessee State University Quillen College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primary Care Group of West GeorgiaGroup PAC ID 6709772197, 9 clinicians

Practice addresses (Care Compare)

100 Professional PL
Suite 204
Carrollton, GA 30117-3802

700 Alabama Ave S
Bremen, GA 30110-2304
Phone (770) 834-3351

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
046974GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Group of West Georgia Family Medicine CurrentSince Aug 1, 1999 Accepting new patients
Primary Care Group of West Georgia Family Medicine PastSince Jan 1, 1990 Accepting new patients

Locations

100 Professional Pl
Ste 204
Carrollton, GA 30117
Phone (770) 834-3351

Interoperability endpoints

  • Direct secure messaging: jjellicorse@pcgofwestga.gwaydirect.com

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348012800000",
    "number": "1932190535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL PARK",
            "address_2": "SUITE 204",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173874",
            "telephone_number": "770-834-3351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL PARK",
            "address_2": "SUITE 204",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173874",
            "telephone_number": "770-834-3351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JELLICORSE",
        "first_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2012-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "046974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00823028A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "080157122",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "728652",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.