Individual provider Active NPI

Michael Harris Callahan, M.D.

  • Otolaryngic Allergy Physician
  • Gainesville, GA
National Provider Identifier
1063564243
Registry record updated Oct 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngic Allergy PhysicianTaxonomy code 207YX0602X
License
045050 Issued in GA
Practice address
584 Lanier Park Dr
Gainesville, GA 30501-2000
Phone
(770) 534-5208
Fax
(770) 534-8512
NPI assigned
Jan 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngic Allergy Physician 207YX0602X 045050 GA Primary

Addresses

Primary practice location

584 Lanier Park Dr
Gainesville, GA 30501-2000

Mailing address

2406 Lighthouse Manor Dr
Gainesville, GA 30501-7401
Phone (770) 536-4352

Other identifiers 1

IdentifierTypeStateIssuer
00906386AMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110627000433 GA Practitioner - Otolaryngology 2860670676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Medical College of Georgia School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Georgia OtolaryngologyGroup PAC ID 3173550464, 12 clinicians

Practice addresses (Care Compare)

1235 Friendship Rd
Suite 100
Braselton, GA 30517-5624
Phone (770) 536-4352

2406 Lighthouse Manor Dr
Gainesville, GA 30501-7401
Phone (770) 536-4352

Hospital & facility affiliations

  • Northeast Georgia Medical Center, Inc Hospital, Gainesville, GA, CCN 110029
  • Northeast Georgia Medical Center Habersham Hospital, Demorest, GA, CCN 110041

Merit-based Incentive Payment System (MIPS)

Final score
94.9 of 100Reported as group
Promoting interoperability
94
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
045050GAMDOtolaryngic Allergy Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Georgia Otolaryngology CurrentSince Aug 1, 2011 Accepting new patients
Limestone Surgery Center LLC CurrentSince Jan 1, 2013 Accepting new patients

Locations

1235 Friendship Rd
Ste 100
Braselton, GA 30517
Phone (770) 536-4352

2406 Lighthouse Manor Dr
Gainesville, GA 30501
Phone (404) 536-4352

Organizations & group practices 2

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

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317686400000",
    "number": "1063564243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2406 LIGHTHOUSE MANOR DR",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305017401",
            "telephone_number": "770-536-4352",
            "fax_number": "770-532-8165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "584 LANIER PARK DR",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012000",
            "telephone_number": "770-534-5208",
            "fax_number": "770-534-8512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLAHAN",
        "first_name": "MICHAEL",
        "middle_name": "HARRIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2011-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0602X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "GA",
            "license": "045050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00906386A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.