Individual provider Active NPI

Michael B Dinerman, MD

  • Pediatrics Physician
  • Atlanta, GA
National Provider Identifier
1962442079
Registry record updated Dec 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
051312 Issued in GA
Practice address
1065 Balmoral Rd NE
Atlanta, GA 30319-1017
Phone
(404) 944-7523
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 051312 GA Primary

Addresses

Primary practice location

1065 Balmoral Rd NE
Atlanta, GA 30319-1017

Mailing address

1065 Balmoral Rd NE
Atlanta, GA 30319-1017
Phone (404) 944-7523

Other identifiers 1

IdentifierTypeStateIssuer
000945876MedicaidGA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080716000501 GA Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 7315010808 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
051312GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Coverage, LLC CurrentSince May 1, 2016 Accepting new patients
Gwinnett Emergency Specialists, LLC CurrentSince Sep 1, 2008 Accepting new patients
Gwinnett Emergency Specialists Observation Services, LLC CurrentSince Aug 1, 2011 Accepting new patients
Peachtree Emergency Physicians LLC Past Accepting new patients

Locations

1200 Memorial Dr
Dalton, GA 30720
Phone (706) 272-6115

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

Organizations & group practices 4

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260835200000",
    "number": "1962442079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 BALMORAL RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303191017",
            "telephone_number": "404-944-7523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1065 BALMORAL RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303191017",
            "telephone_number": "404-944-7523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DINERMAN",
        "first_name": "MICHAEL",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2009-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "051312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000945876",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.