NPIMap

Organization Active NPI

Physician Consultants of Georgia

  • Nephrology Physician
  • Macon, GA
National Provider Identifier
1962762708
Registry record updated Nov 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
055819 Issued in GA
Legal business name
PHYSICIAN CONSULTANTS OF GEORGIA
Practice address
1425 Georgia Ave Ste 201a
Macon, GA 31201-6546
Phone
(478) 250-1325
NPI assigned
May 28, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2020

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

Authorized official

Name
Reuben Kristian Ellis, MDNPI 1114969110
Title
Owner/Physician
Phone
(404) 877-8115

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X 055819 GA Primary

Addresses

Primary practice location

1425 Georgia Ave Ste 201a
Macon, GA 31201-6546

Mailing address

PO Box 6612
Macon, GA 31208-6612
Phone (478) 250-1325

Other practice location 1

1445 Georgia Ave
Suite 3
Macon, GA 31201-7610
Phone (478) 250-1325

Other identifiers 1

IdentifierTypeStateIssuer
003126259AMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120716000368 GA Part B Supplier - Clinic/Group Practice 5193981314 Receives reassigned benefits from 6 practitioners
Practice locations: Macon, GA

National Provider Directory

National Provider Directory

Locations

1425 Georgia Ave
Ste 201A
Macon, GA 31201
Phone (478) 250-1325

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1338163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605744000000",
    "number": "1962762708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6612",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312086612",
            "telephone_number": "478-250-1325",
            "fax_number": "478-254-6860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 GEORGIA AVE STE 201A",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312016546",
            "telephone_number": "478-250-1325"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1445 Georgia Ave",
            "address_2": "Suite 3",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312017610",
            "country_code": "US",
            "telephone_number": "478-250-1325",
            "fax_number": "478-250-1330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHYSICIAN CONSULTANTS OF GEORGIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-28",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "REUBEN",
        "authorized_official_middle_name": "KRISTIAN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "404-877-8115",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "055819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003126259A",
            "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 Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.