Individual provider Active NPI

Jennifer Wendy Freeman Fortier, CNM

  • Advanced Practice Midwife
  • Atlanta, GA
National Provider Identifier
1962632315
Registry record updated Mar 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
RN 154520 Issued in GA
Practice address
2525 Cumberland Pkwy SE
Atlanta, GA 30339-3915
Phone
(404) 365-0966
NPI assigned
Jul 20, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X RN 154520 GA Primary

Addresses

Primary practice location

2525 Cumberland Pkwy SE
Atlanta, GA 30339-3915

Mailing address

3495 Piedmont Rd NE
Atlanta, GA 30305-1717
Phone (404) 365-0966

Other names 1

  • Jennifer Wendy Freeman Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090831000391 GA Practitioner - Certified Nurse Midwife (CNM) 9032264825 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
RN 154520GAMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
The Southeast Permanente Medical Group Advanced Practice Midwife CurrentSince Jan 1, 2020 Accepting new patients

Locations

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

2525 Cumberland Pkwy SE
Atlanta, GA 30339
Phone (770) 431-4145

Organizations & group practices 1

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": "1248048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647907200000",
    "number": "1962632315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303051717",
            "telephone_number": "404-365-0966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 CUMBERLAND PKWY SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303393915",
            "telephone_number": "404-365-0966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTIER",
        "first_name": "JENNIFER",
        "middle_name": "WENDY FREEMAN",
        "name_prefix": "Ms.",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-20",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "GA",
            "license": "RN 154520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2525 Cumberland Pkwy SE",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303393915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "FREEMAN",
            "middle_name": "WENDY",
            "credential": "CNM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.