Mr Keith Wesley Fort, PA-C - Medicare Physician Assistant in Jonesboro, GA

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Mr Keith Wesley Fort, PA-C is a medicare enrolled "Physician Assistant" in Jonesboro, Georgia. He graduated from nursing school in 2008 and has 18 years of diverse experience with area of expertise as Physician Assistant. He is a member of the group practice The Southeast Permanente Medical Group, Physiotherapy Associates Inc and his current practice location is 2400 Mount Zion Pkwy, Kaiser Permanente Southwood Medical Center, Jonesboro, Georgia. You can reach out to his office (for appointments etc.) via phone at (201) 943-9100.

Mr Keith Wesley Fort is licensed to practice in Georgia (license number 006400) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1487888061.

Contact Information

Mr Keith Wesley Fort, PA-C
2400 Mount Zion Pkwy, Kaiser Permanente Southwood Medical Center,
Jonesboro, GA 30236-2500
(201) 943-9100
(201) 943-7308

Map and Direction




Provider's Profile

Full NameMr Keith Wesley Fort
GenderMale
SpecialityPhysician Assistant
Experience18 Years
Location2400 Mount Zion Pkwy, Jonesboro, Georgia
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Mr Keith Wesley Fort graduated from nursing school in 2008
  NPI Data:
  • NPI Number: 1487888061
  • Provider Enumeration Date: 05/11/2009
  • Last Update Date: 01/10/2022
  Medicare PECOS Information:
  • PECOS PAC ID: 1456407170
  • Enrollment ID: I20120514000406

Medical Identifiers

Medical identifiers for Mr Keith Wesley Fort such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1487888061NPI-NPPES
162546NMSOtherNJMEDICARE PTAN

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363A00000XPhysician Assistant 6400 (Georgia)Secondary
363AS0400XPhysician Assistant - Surgical 25MP00214500 (New Jersey)Secondary
363A00000XPhysician Assistant 006400 (Georgia)Primary

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
The Southeast Permanente Medical Group6204829013823
Physiotherapy Associates Inc35774704421432

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Keith Wesley Fort allows following entities to bill medicare on his behalf.
Entity NameThe Southeast Permanente Medical Group
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1245266956
PECOS PAC ID: 6204829013
Enrollment ID: O20040407000370
Entity NameLagrange Emergency Physicians, LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1760437560
PECOS PAC ID: 0840207072
Enrollment ID: O20060314000271
Entity NameThe Bortolazzo Group, LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1801965082
PECOS PAC ID: 3476554320
Enrollment ID: O20070122000015
Entity NamePiedmont Ed Professionals LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1932477429
PECOS PAC ID: 1759543176
Enrollment ID: O20120501000744

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Keith Wesley Fort is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Mr Keith Wesley Fort, PA-C
3495 Piedmont Rd Ne, Nine Piedmont Center,
Atlanta, GA 30305-1717

Ph: (404) 504-5678		Mr Keith Wesley Fort, PA-C
2400 Mount Zion Pkwy, Kaiser Permanente Southwood Medical Center,
Jonesboro, GA 30236-2500

Ph: (201) 943-9100

Reviews and Comments


Physician Assistant Nurses in Jonesboro, GA

Teresa Cleaves, CSA
Physician Assistant
Medicare: Not Enrolled in Medicare
Practice Location: 804 River Mist Dr, Jonesboro, GA 30238
Phone: 770-985-4257    Fax: 770-985-4258
Mr. Jerome A Maislis, PA-C
Physician Assistant
Medicare: Not Enrolled in Medicare
Practice Location: 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Comprehensive Medical Cente, Jonesboro, GA 30236
Phone: 770-603-3649    
Stephanie Summerhill-brcka, PA
Physician Assistant
Medicare: Not Enrolled in Medicare
Practice Location: 2400 Mount Zion Pkwy, Jonesboro, GA 30236
Phone: 404-365-0966    
Karen Dixon, CSA
Physician Assistant
Medicare: Not Enrolled in Medicare
Practice Location: 325 Fieldstone Pkwy, Jonesboro, GA 30236
Phone: 678-499-5103    Fax: 770-629-5554
Meghan C Campbell, PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 2400 Mount Zion Pkwy, Kaiser Permanente Southwood Comprehensive Medical Ctr, Jonesboro, GA 30236
Phone: 770-603-3649    
Melissa Ramirez,
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 2400 Mount Zion Pkwy, Jonesboro, GA 30236
Phone: 404-365-0966    
Phuongtin Ta,
Physician Assistant
Medicare: Not Enrolled in Medicare
Practice Location: 2480 Brighton Trl, Jonesboro, GA 30236
Phone: 404-980-8861    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

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