Jacqueline Nicole Flandry, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

070111 Issued in GA

Practice address

1150 Brookstone Centre Pkwy
Columbus, GA 31904-4577

Phone

(706) 257-4189

Fax

(706) 257-4194

NPI assigned

Apr 13, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Jacqueline Nicole Flandry Fussell Former name

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

Dermatology

Education

Medical College of Georgia School of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aqua Dermatology of Georgia PCGroup PAC ID 6800885757, 56 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Columbus Regional Midtown Hospital, Columbus, GA, CCN 110064

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Aqua Dermatology of Georgia PC

  dba Goodman Dermatology, Skin Cancer Specialists PC & Aesthetics Center

  • Dermatology Physician
  • Marietta, GA
  • NPI 1114022167

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Dermatopathology Lab of Skin Cancer Specialists, P.C.

  • Clinical Medical Laboratory
  • Marietta, GA
  • NPI 1083044465
  NPD

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

• The Medical Center Inc

  dba Piedmont Columbus Regional Midtown

  • General Acute Care Hospital
  • Columbus, GA
  • NPI 1255401519
  Care Compare affiliation

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

{
    "created_epoch": "1239580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592352000000",
    "number": "1306089800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 COGBURN AVE NW STE 250",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601056",
            "telephone_number": "770-422-8815",
            "fax_number": "770-422-8816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 BROOKSTONE CENTRE PKWY",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319044577",
            "telephone_number": "706-257-4189",
            "fax_number": "706-257-4194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLANDRY",
        "first_name": "JACQUELINE",
        "middle_name": "NICOLE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-13",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "70111",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "GA",
            "license": "070111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "202G708679",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003159653A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jflandry@directaddress.net",
            "affiliation": "N",
            "address_1": "1150 Brookstone Centre Pkwy",
            "city": "Columbus",
            "state": "GA",
            "country_code": "US",
            "postal_code": "319044577",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "FUSSELL",
            "middle_name": "NICOLE FLANDRY",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristopher Malachi Fitch, MS
• Tonia Fitzpatrick
• Five Star Counseling Services LLC (Fab Five Counseling Services)
• Five Talents and Five Senses L.L.C. (Ten Talents L.L.C.)
• Frederick C. Flandry, M.D.
• Joann Flantroy
• Hannah Elizabeth Flatley, PA-C
• Jerome A Fleischer, PH.D.
• Judy Gail Fleischer
• Christina Lynn Fleitas, APRN

• Dermatology Physician in Columbus, GA
• Providers in Columbus, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; 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.