NPIMap

Organization Active NPI

Cardiology Care Clinic, LLC

  • Cardiovascular Disease Physician
  • Eatonton, GA
National Provider Identifier
1962764639
Registry record updated Jul 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
CARDIOLOGY CARE CLINIC, LLC
Practice address
119 Harmony Xing Ste 3
Eatonton, GA 31024-9571
Phone
(706) 485-4004
Fax
(706) 262-2986
NPI assigned
Jun 8, 2012
Last updated
Jul 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2020

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

Authorized official

Name
Nicolas A.F. Chronos, MDNPI 1427057165
Title
Owner
Phone
(706) 485-4004

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X
Cardiovascular Disease Physician 207RC0000X Primary
Cardiac Rehabilitation Clinic/Center 261QR0404X

Addresses

Primary practice location

119 Harmony Xing Ste 3
Eatonton, GA 31024-9571

Mailing address

119 Harmony Xing Ste 3
Eatonton, GA 31024-9571
Phone (706) 485-4004

Other practice location 1

117 Harmony Xing Ste 1
Eatonton, GA 31024-9548
Phone (706) 485-4004

Other identifiers 1

IdentifierTypeStateIssuer
003126643AMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120725000273 GA Part B Supplier - Clinic/Group Practice 4385800093 Receives reassigned benefits from 14 practitioners
Practice locations: Eatonton, GA

National Provider Directory

National Provider Directory

Locations

117 Harmony Xing
Eatonton, GA 31024

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1339113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595808000000",
    "number": "1962764639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 HARMONY XING STE 3",
            "city": "EATONTON",
            "state": "GA",
            "postal_code": "310249571",
            "telephone_number": "706-485-4004",
            "fax_number": "706-292-2986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 HARMONY XING STE 3",
            "city": "EATONTON",
            "state": "GA",
            "postal_code": "310249571",
            "telephone_number": "706-485-4004",
            "fax_number": "706-262-2986"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "117 Harmony Xing Ste 1",
            "address_purpose": "LOCATION",
            "city": "Eatonton",
            "state": "GA",
            "postal_code": "310249548",
            "country_code": "US",
            "telephone_number": "706-485-4004",
            "fax_number": "706-292-2986",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CARDIOLOGY CARE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-08",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A",
        "authorized_official_last_name": "CHRONOS",
        "authorized_official_first_name": "NICOLAS",
        "authorized_official_middle_name": "A.F.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-485-4004",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0404X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Cardiac Facilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003126643A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eatonton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.