NPIMap

Individual provider Active NPI

Mark Vining Hendricks, M.D

  • Pulmonary Disease Physician
  • Macon, GA
National Provider Identifier
1306827639
Registry record updated Oct 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
043061 Issued in GA
Practice address
840 Pine Street
Suite 780
Macon, GA 31201
Phone
(478) 744-2445
Fax
(478) 744-0906
NPI assigned
Nov 14, 2005
Last updated
Oct 26, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 043061 GA
Pulmonary Disease Physician 207RP1001X 043061 GA Primary

Addresses

Primary practice location

840 Pine Street
Suite 780
Macon, GA 31201

Mailing address

840 Pine Street
Suite 780
Macon, GA 31201
Phone (478) 744-2445

Other identifiers 2

IdentifierTypeStateIssuer
290013678OtherGAMEDICARE RAILROAD
000904219AMedicaidGA

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
I20040615000834 GA Practitioner - Pulmonary Disease 8527054907 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Medical College of Georgia School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Avilys-Sleep and EegGroup PAC ID 7719303072, 10 clinicians
Central Georgia Pulmonary Associates, LLCGroup PAC ID 0648266015, 8 clinicians

Practice addresses (Care Compare)

2300 Northside Xing
Suite B
Macon, GA 31210-2254
Phone (855) 228-4597

458 Hemlock St
Suite 200
Macon, GA 31201-4200
Phone (478) 744-2445

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
043061GAMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ga Diagnostic Providers LLC CurrentSince Jan 14, 2022 Accepting new patients
Avilys-Sleep & Eeg CurrentSince Jan 14, 2022 Accepting new patients
Central Georgia Kidney Specialists, PC Past Accepting new patients
Central Georiga Fertility Institute Past Accepting new patients

Locations

2300 Northside Xing
#B
Macon, GA 31210
Phone (855) 228-4597

5400 Riverside Dr
Ste 101
Macon, GA 31210

5400 Riverside Dr
Ste 202
Macon, GA 31210
Phone (478) 787-0059

100 Tommy Stalnaker Dr
Ste 100A
Warner Robins, GA 31088
Phone (478) 787-0059

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JIFEAA
  • Direct secure messaging: mark.hendricks@cgpa.eclinicaldirectplus.com
  • Direct secure messaging: mhendricks433802@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 5

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 5

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": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351209600000",
    "number": "1306827639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 PINE STREET",
            "address_2": "SUITE 780",
            "city": "MACON",
            "state": "GA",
            "postal_code": "31201",
            "telephone_number": "478-744-2445",
            "fax_number": "478-744-0906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 PINE STREET",
            "address_2": "SUITE 780",
            "city": "MACON",
            "state": "GA",
            "postal_code": "31201",
            "telephone_number": "478-744-2445",
            "fax_number": "478-744-0906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "MARK",
        "middle_name": "VINING",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-14",
        "last_updated": "2012-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "GA",
            "license": "043061",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "GA",
            "license": "043061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "290013678",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000904219A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.