NPIMap

Individual provider Active NPI

Mary E McKinley, MD

  • Internal Medicine Physician
  • Macon, GA
National Provider Identifier
1023003993
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
T2435 Issued in TX
Practice address
360 Hospital Dr
Suite 110
Macon, GA 31217-3874
Phone
(478) 841-2707
Fax
(478) 841-2708
NPI assigned
Sep 15, 2005
Last updated
Nov 23, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 51256 GA
Internal Medicine Physician 207R00000X T2435 TX Primary
Pediatrics Physician 208000000X 051256 GA

Addresses

Primary practice location

360 Hospital Dr
Suite 110
Macon, GA 31217-3874

Mailing address

360 Hospital Dr
Suite 110
Macon, GA 31217-3874
Phone (478) 841-2707

Other practice location 1

1015 Gibbins Rd Ste A
Arlington, TX 76011-5615
Phone (972) 734-5400

Other identifiers 1

IdentifierTypeStateIssuer
000954005AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20031107000483 GA Practitioner - Internal MedicinePractitioner - Pediatric Medicine 0446163240 Reassigns benefits to 4 organizations
I20211022000447 TX Practitioner - Internal Medicine 0446163240 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Louisiana State University School of Medicine in New Orleans, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Texas Faith LLCGroup PAC ID 9032512900, 10 clinicians
Chronic Disease Management of Georgia LLCGroup PAC ID 7618306721, 76 clinicians

Practice addresses (Care Compare)

1015 Gibbins Rd
Suite a
Arlington, TX 76011-5615
Phone (972) 734-5400

360 Hospital Dr
Suite 110
Macon, GA 31217-8052
Phone (478) 841-2707

704 Breedlove Dr
Suite a
Monroe, GA 30655-2054
Phone (888) 772-0076

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
51256GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optimus Diagnostics LLC Current Accepting new patients
Texas Faith LLC CurrentSince Oct 18, 2021 Accepting new patients
Community Primary Care of Georgia LLC CurrentSince Jun 1, 2016 Accepting new patients
Im-Peds Primary Care LLC Internal Medicine CurrentSince Oct 1, 2006 Accepting new patients
Transitional Care Physicians of Georgia PC CurrentSince Sep 1, 2022 Accepting new patients
Chronic Disease Management of Georgia, LLC CurrentSince Aug 1, 2023 Accepting new patients
Kumock PLLC Internal Medicine CurrentSince Nov 5, 2023 Accepting new patients
Jones County Nursing Home LLC Past Accepting new patients
Coliseum Health Group LLC Past Accepting new patients
Eastview Healthcare, LLC Past Accepting new patients

Locations

4421 Carnes St
Acworth, GA 30101
Phone (478) 621-2072

1005 Boulder Dr
Gray, GA 31032
Phone (478) 621-2072

343 Plantation Way
Macon, GA 31210
Phone (478) 405-9000

360 Hospital Dr
Ste 110
Macon, GA 31217
Phone (478) 464-1340

704 Breedlove Dr
#A
Monroe, GA 30655
Phone (888) 772-0076

1015 Gibbins Rd
Ste A
Arlington, TX 76011
Phone (972) 734-5400

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GCJEAA
  • FHIR API: https://fhir4.healow.com/fhir/r4/GCJEAA/Endpoint/GCJEAA
  • Direct secure messaging: maryevelyn.mckinley@peds.eclinicaldirectplus.com
  • Direct secure messaging: mmckinley433807@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1023003993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 HOSPITAL DR",
            "address_2": "SUITE 110",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312173874",
            "telephone_number": "478-841-2707",
            "fax_number": "478-841-2708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 HOSPITAL DR",
            "address_2": "SUITE 110",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312173874",
            "telephone_number": "478-841-2707",
            "fax_number": "478-841-2708"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1015 Gibbins Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TX",
            "postal_code": "760115615",
            "country_code": "US",
            "telephone_number": "972-734-5400",
            "fax_number": "972-734-5433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKINLEY",
        "first_name": "MARY",
        "middle_name": "E",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-15",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "51256",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "T2435",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "051256",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000954005A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.