NORTHEAST GEORGIA PHYSICIANS GROUP INC – Family Medicine Physician, NPI 1891745212
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for NORTHEAST GEORGIA PHYSICIANS GROUP INC
Rice Box, Atlanta BeltLine Eastside Trail, Atlanta, Fulton County, Georgia, 30308, United States
ATLANTA, GA 303742616
Phone: (770) 219-8420
Fax: (770) 219-8440
Type: Mailing
Northeast Georgia Medical Center, 743, Spring Street Northeast, Gainesville, Hall County, Georgia, 30501, United States
GAINESVILLE, GA 305013715
Phone: (770) 219-9000
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: 2026-03-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 12 Medicare enrollment records; no due dates published yet.
Enrollment records
12
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 |
|---|---|---|---|---|
| O20040402001277 | O | Clinic/Group Practice | GA | TBD |
| O20250930004021 | O | Clinic/Group Practice | FL | TBD |
| O20251029000612 | O | Clinic/Group Practice | SC | TBD |
| O20251029004454 | O | Clinic/Group Practice | TX | TBD |
| O20251125003139 | O | Clinic/Group Practice | MI | TBD |
| O20251202000329 | O | Clinic/Group Practice | PR | TBD |
| O20251202001076 | O | Clinic/Group Practice | CT | TBD |
| O20251205002209 | O | Clinic/Group Practice | DC | TBD |
| O20260123003040 | O | Clinic/Group Practice | AL | TBD |
| O20260204004224 | O | Clinic/Group Practice | NC | TBD |
| O20260218000433 | O | Clinic/Group Practice | MN | TBD |
| O20260313002521 | O | Clinic/Group Practice | MA | 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 30374)
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