NPIMap

Individual provider Active NPI

Yilikal Tassew Kassa, MD

  • Nephrology Physician
  • Conyers, GA
National Provider Identifier
1114222676
Registry record updated Apr 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
070175 Issued in GA
Practice address
1612 Milstead Rd NE
Suite a
Conyers, GA 30012-3738
Phone
(678) 413-3261
Fax
(678) 413-3580
NPI assigned
Jan 14, 2011
Last updated
Apr 7, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 070175 GA Primary

Addresses

Primary practice location

1612 Milstead Rd NE
Suite a
Conyers, GA 30012-3738

Mailing address

PO Box 1157
Covington, GA 30015-1157
Phone (678) 413-3261

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130718000439 GA Practitioner - Nephrology 8628217460 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Eastside Premier Nephrology and Hypertension PCGroup PAC ID 5991735037, 3 clinicians

Practice addresses (Care Compare)

1612 Milstead Rd NE
Suite a
Conyers, GA 30012-3738
Phone (678) 413-3261

4570 Memorial Dr
Suite B
Decatur, GA 30032-1444
Phone (678) 413-3261

8425 Mall Pkwy
Stonecrest, GA 30038-6914
Phone (678) 413-3261

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
070175GAMDNephrology Physician

Interoperability endpoints

  • Direct secure messaging: ykassa25516@direct.acumenmd.com

Organizations & group practices 1

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 10

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": "1294963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459987200000",
    "number": "1114222676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1157",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300151157",
            "telephone_number": "678-413-3261",
            "fax_number": "678-413-3580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 MILSTEAD RD NE",
            "address_2": "SUITE A",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123738",
            "telephone_number": "678-413-3261",
            "fax_number": "678-413-3580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASSA",
        "first_name": "YILIKAL",
        "middle_name": "TASSEW",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-14",
        "last_updated": "2016-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "070175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

Verify at the official NPI Registry.