GEORGIA MEDICAL CLINIC
NPI 1124361811
Internal Medicine in Cumming, GA
About Georgia Medical Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GEORGIA MEDICAL CLINIC (NPI 1124361811) is a healthcare organization registered as an internal medicine in Cumming, Georgia and active in the NPI registry since April 2013. The organization holds a CLIA Waiver certificate valid through January 18, 2027 and lists Venkatappa Rangaraj, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Georgia Medical Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to Georgia Medical Clinic, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (3)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 11D2209987
Georgia Medical Clinic · Cumming, GAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Blackpool LLC's NPI number?
The NPI number for Blackpool LLC is 1124361811. It was assigned to this organization in the NPPES registry on April 1, 2013. The provider is doing business as Georgia Medical Clinic.
Where is Blackpool LLC located?
Blackpool LLC is located at 4415 Front Nine Dr Ste 600, Cumming, GA 30041. The listed phone number is (770) 744-7688.
What is Blackpool LLC's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Blackpool LLC enrolled in Medicare?
Yes. Blackpool LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Blackpool LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Blackpool LLC, in Internal Medicine and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Blackpool LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D2209987) is associated with this NPI, valid through January 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Blackpool LLC accept?
Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Blackpool LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Blackpool LLC was last updated on February 14, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Georgia Medical Clinic · NPI 1124361811
Internal Medicine organization in Cumming, Georgia. Organization record, active in the CMS NPPES registry since April 1, 2013.
## Identity
- **NPI:** 1124361811 (Entity type: Organization)
- **Enumerated:** April 1, 2013
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Legal business name:** Blackpool Llc
- **Organization subpart:** No
- **Authorized official:** Venkatappa Rangaraj, OWNER
## Practice location
- **Address:** 4415 FRONT NINE DR STE 600, Cumming, GA 30041-6239
- **Phone:** (770) 744-7688 · **Fax:** (770) 406-1058
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 3 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (2), Internal Medicine (1); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 14, 2023
- **Other identifiers:** Medicaid 003132617A (GA)
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1124361811) · Data from the CMS NPPES public registry.