EXCELSIOR HEALTHCARE LLC – Family Medicine Physician, NPI 1740142843
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for EXCELSIOR HEALTHCARE LLC
4855 River Green Pkwy Ste 520
Duluth, GA 300968337
Phone: (678) 417-1588
Type: Location
777 W PEACHTREE ST
NORCROSS, GA 300711868
Phone:
Type: Mailing
3895 Johns Creek Pkwy Ste B
Suwanee, GA 300241295
Phone: (770) 203-0618
Type: Location
275 Carpenter Dr Ste 100
Atlanta, GA 303284909
Phone: (404) 497-9739
Type: Location
2805 Hamilton Mill Rd
Buford, GA 305194110
Phone: (678) 541-0588
Type: Location
277 E Crogan St
Lawrenceville, GA 300465054
Phone: (770) 822-4411
Type: Location
4470 Satellite Blvd Ste 204
Duluth, GA 300968851
Phone: (770) 858-5983
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-12-26
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20251226001745 | O | Clinic/Group Practice | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30096)
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Reviews
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