KINGDOM HEALTHCARE SERVICES, LLC
NPI 1750913349
Clinic/Center - Primary Care in Hiram, GA
About Kingdom Healthcare Services, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KINGDOM HEALTHCARE SERVICES, LLC (NPI 1750913349) is a healthcare organization registered as a primary care in Hiram, Georgia and active in the NPI registry since February 2020. The organization maintains a secondary practice location in Dallas and lists Lucille M Travis, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kingdom Healthcare Services, Llc 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 Kingdom Healthcare Services, LLC, 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.
Frequently 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 Kingdom Healthcare Services, LLC's NPI number?
The NPI number for Kingdom Healthcare Services, LLC is 1750913349. It was assigned to this organization in the NPPES registry on February 11, 2020.
Where is Kingdom Healthcare Services, LLC located?
Kingdom Healthcare Services, LLC is located at 4095 Atlanta Hwy, Hiram, GA 30141. The listed phone number is (404) 488-9521.
What is Kingdom Healthcare Services, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Kingdom Healthcare Services, LLC enrolled in Medicare?
Yes. Kingdom Healthcare Services, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Kingdom Healthcare Services, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Kingdom Healthcare Services, LLC. 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.
When was this NPI record last updated?
The NPPES record for Kingdom Healthcare Services, LLC was last updated on October 22, 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.
# Kingdom Healthcare Services, Llc · NPI 1750913349
Primary Care organization in Hiram, Georgia. Organization record, active in the CMS NPPES registry since February 11, 2020.
## Identity
- **NPI:** 1750913349 (Entity type: Organization)
- **Enumerated:** February 11, 2020
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Lucille Travis, CEO
## Practice location
- **Address:** 4095 ATLANTA HWY, Hiram, GA 30141-1854
- **Phone:** (404) 488-9521
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 22, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1750913349) · Data from the CMS NPPES public registry.