Individual provider Active NPI

Janice K. Bain, M.D.

  • Internal Medicine Physician
  • Mableton, GA
National Provider Identifier
1093704645
Registry record updated Jan 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
056967 Issued in GA
Practice address
4885 Collins Lake Dr
Mableton, GA 30126-1794
Phone
(470) 725-2496
NPI assigned
Oct 17, 2005
Last updated
Jan 13, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD60452100 WA
Internal Medicine Physician 207R00000X 056967 GA Primary

Addresses

Primary practice location

4885 Collins Lake Dr
Mableton, GA 30126-1794

Mailing address

4885 Collins Lake Dr
Mableton, GA 30126-1794
Phone (470) 725-2496

Other practice location 1

820 N Chelan Ave
Wenatchee, WA 98801-2028
Phone (509) 663-8711

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE) Permanente Medical Group

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
I20051110000078 GA Practitioner - Internal Medicine 6305864174 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

750 Townpark LN NW
Kennesaw, GA 30144-5579
Phone (770) 514-5405

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
056967GAMDInternal Medicine Physician
MD60452100WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Southeast Permanente Medical Group Internal Medicine CurrentSince Apr 22, 2020 Accepting new patients
Cooperative Healthcare Services Inc Internal Medicine CurrentSince Jun 3, 2012 Accepting new patients
Emergency Coverage Services, PC Past Accepting new patients
Wellstar Physicians Group Douglas Hospitalists, LLC Internal Medicine Past Accepting new patients
Emergency Coverage, LLC Internal Medicine Past Accepting new patients
York Physician Services PC Past Accepting new patients
Ecc Hospitalist Services PC Internal Medicine Past Accepting new patients

Locations

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

2415 Parkwood Dr
Brunswick, GA 31520
Phone (912) 466-4079

750 Townpark Ln NW
Kennesaw, GA 30144
Phone (770) 514-5401

5665 Ptree Dunwoody Rd NE
Sandy Springs, GA 30342
Phone (678) 843-7001

Organizations & group practices 7

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 1

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": "1129507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1093704645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4885 COLLINS LAKE DR",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301261794",
            "telephone_number": "470-725-2496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4885 COLLINS LAKE DR",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301261794",
            "telephone_number": "470-725-2496"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "820 N Chelan Ave",
            "address_purpose": "LOCATION",
            "city": "Wenatchee",
            "state": "WA",
            "postal_code": "988012028",
            "country_code": "US",
            "telephone_number": "509-663-8711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAIN",
        "first_name": "JANICE",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-17",
        "last_updated": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD60452100",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "056967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5665 Peachtree Dunwoody Rd",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303421764",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mableton, GA

Sources for this page

Verify at the official NPI Registry.