Godly Obomate Jack, MD

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

98756 Issued in GA

Practice address

150 Gentilly Blvd
Cartersville, GA 30120-8522

Phone

(470) 490-6670

Fax

(770) 382-5762

NPI assigned

Apr 24, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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

Specialty

Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Harbin Clinic LLCGroup PAC ID 0446154231, 238 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Cartersville Medical Center Hospital, Cartersville, GA, CCN 110030
• Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143

Merit-based Incentive Payment System (MIPS)

Final score

83.23 of 100Reported as group

Quality

65.74

Promoting interoperability

100

Improvement activities

40

Cost

78.37

Merit-based Incentive Payment System (MIPS)

Final score

72.91 of 100Reported as group

Quality

50.88

Improvement activities

40

Cost

69.9

Merit-based Incentive Payment System (MIPS)

Final score

86.36 of 100Reported as group

Quality

80.89

Improvement activities

40

Cost

75.39

Merit-based Incentive Payment System (MIPS)

Final score

87.23 of 100Reported as group

Quality

80.47

Promoting interoperability

100

Improvement activities

40

Cost

76.96

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gjack2994697@carolinashealthcaresystem.direct-ci.com

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.

• Harbin Clinic, LLC

  • Multi-Specialty Clinic/Center
  • Rome, GA
  • NPI 1679599088
  Medicare reassignment Care Compare group NPD
• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  Medicare reassignment NPD
• Harbin Clinic, LLC

  • Ambulatory Surgical Clinic/Center
  • Rome, GA
  • NPI 1447385158
  NPD
• Harbin Clinic, LLC

  • Ambulatory Surgical Clinic/Center
  • Cartersville, GA
  • NPI 1467016055
  NPD

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

• Cartersville Medical Center LLC

  • General Acute Care Hospital
  • Cartersville, GA
  • NPI 1780638833
  Care Compare affiliation
• Cobb Hospital, Inc

  • General Acute Care Hospital
  • Austell, GA
  • NPI 1467420448
  Care Compare affiliation

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

{
    "created_epoch": "1492992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1114452588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 TECHNOLOGY PKWY NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651369",
            "telephone_number": "762-235-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 GENTILLY BLVD",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301208522",
            "telephone_number": "470-490-6670",
            "fax_number": "770-382-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "GODLY",
        "middle_name": "OBOMATE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-24",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "98756",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "GA",
            "license": "98756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "godly.jack.1@1498.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "150 Gentilly Blvd",
            "city": "Cartersville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301208522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Angela Irish, LPC
• Lourdes Cristina Irizar, ARNP
• Isd Renal Inc
• Muhammad Rashid Ishaque, M.D.
• Jennifer Jabaley, O.D.
• Demetria A Jackson, NP
• Terry E Jacobs, M.D.
• Juthika Marie Jajal, D.C.
• Harini Jalagani, MD
• Leah Marie Grace James

• Interventional Cardiology Physician in Cartersville, GA
• Providers in Cartersville, GA by specialty
• Interventional Cardiology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.