KENNESAW MOUNTAIN MEDICAL GROUP
NPI 1235378324
Clinic/Center - Primary Care in Kennesaw, GA
About Kennesaw Mountain Medical Group NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KENNESAW MOUNTAIN MEDICAL GROUP (NPI 1235378324) is a healthcare organization registered as a primary care in Kennesaw, Georgia and active in the NPI registry since February 2009. The organization holds a CLIA Waiver certificate valid through May 11, 2027 and lists Gregory J Matechak, Physician, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kennesaw Mountain Medical Group is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Kennesaw Mountain Medical Group, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 11D1099359
Kennesaw Mountain Medical Grap · Kennesaw, 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 Kennesaw Mountain Medical Group's NPI number?
The NPI number for Kennesaw Mountain Medical Group is 1235378324. It was assigned to this organization in the NPPES registry on February 12, 2009.
Where is Kennesaw Mountain Medical Group located?
Kennesaw Mountain Medical Group is located at 1600 Kennesaw Due West Rd NW Building 600 Suite 625, Kennesaw, GA 30152. The listed phone number is (770) 422-5880.
What is Kennesaw Mountain Medical Group's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Kennesaw Mountain Medical Group enrolled in Medicare?
Yes. Kennesaw Mountain Medical Group is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Kennesaw Mountain Medical Group?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Kennesaw Mountain Medical Group. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Kennesaw Mountain Medical Group hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D1099359) is associated with this NPI, valid through May 11, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Kennesaw Mountain Medical Group was last updated on February 12, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.
# Kennesaw Mountain Medical Group · NPI 1235378324
Primary Care organization in Kennesaw, Georgia. Organization record, active in the CMS NPPES registry since February 12, 2009.
## Identity
- **NPI:** 1235378324 (Entity type: Organization)
- **Enumerated:** February 12, 2009
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Gregory Matechak, PHYSICIAN
## Practice location
- **Address:** 1600 KENNESAW DUE WEST RD NW, BUILDING 600 SUITE 625, Kennesaw, GA 30152-4301
- **Phone:** (770) 422-5880
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 12, 2009
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1235378324) · Data from the CMS NPPES public registry.