Individual provider Active NPI

Kaine Copeland

  • Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1144084385
Registry record updated Feb 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN219726 Issued in GA
Practice address
2572 Centennial CV
Atlanta, GA 30349-8633
Phone
(678) 438-2779
NPI assigned
Feb 8, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN219726 GA Primary

Addresses

Primary practice location

2572 Centennial CV
Atlanta, GA 30349-8633

Mailing address

2572 Centennial CV
Atlanta, GA 30349-8633

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250205002358 GA Practitioner - Nurse Practitioner 5698205763 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northside Cardiovascular Professional Services, LLCGroup PAC ID 9739189838, 143 clinicians

Practice addresses (Care Compare)

1285 Upper Hembree Rd
Roswell, GA 30076-1143
Phone (770) 343-8565

2200 Medical Ctr Blvd
Suite G1
Lawrenceville, GA 30046-7751
Phone (404) 962-2500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN219726GAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Cardiovascular Professional Services, LLC CurrentSince Jan 13, 2025 Accepting new patients

Locations

1285 Upper Hembree Rd
Roswell, GA 30076
Phone (770) 343-8565

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1707350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707350400000",
    "number": "1144084385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2572 CENTENNIAL CV",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303498633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2572 CENTENNIAL CV",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303498633",
            "telephone_number": "678-438-2779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPELAND",
        "first_name": "KAINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-08",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN219726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.