NPIMap

Individual provider Active NPI

John Manor Entrekin, MD

  • Internal Medicine Physician
  • Conyers, GA
National Provider Identifier
1336234053
Registry record updated Feb 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
042565 Issued in GA
Practice address
1301 Well Brook Circle
Conyers, GA 30012-3873
Phone
(770) 922-3023
Fax
(770) 929-1016
NPI assigned
Oct 4, 2006
Last updated
Feb 23, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 042565 GA Primary

Addresses

Primary practice location

1301 Well Brook Circle
Conyers, GA 30012-3873

Mailing address

1301 Well Brook Circle
Conyers, GA 30012-3873
Phone (770) 922-3023

Other identifiers 1

IdentifierTypeStateIssuer
00754927AMedicaidGA

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
I20101116000790 GA Practitioner - Internal Medicine 9133314198 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Alabama School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Medical Care CorporationGroup PAC ID 6002802220, 368 clinicians

Practice addresses (Care Compare)

105 Collier Rd NW
Suite 5020
Atlanta, GA 30309-1731
Phone (404) 367-3210

1301 Wellbrook Cir NE
Conyers, GA 30012-3873
Phone (770) 922-3023

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
042565GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Internal Medicine Associates of Rockdale PC Internal Medicine Current Accepting new patients
Piedmont Medical Care Corporation Internal Medicine CurrentSince Oct 29, 2017 Accepting new patients
Piedmont Providers LLC Internal Medicine PastSince Dec 10, 2018 Accepting new patients

Locations

105 Collier Rd NW
Ste 2070
Atlanta, GA 30309
Phone (404) 350-3860

105 Collier Rd NW
Ste 5020
Atlanta, GA 30309
Phone (404) 350-3860

2727 Paces Ferry Rd SE
Ste 1-1100
Atlanta, GA 30339
Phone (470) 271-3421

1301 Wellbrook Cir NE
Conyers, GA 30012
Phone (404) 922-3023

Organizations & group practices 4

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 6

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266883200000",
    "number": "1336234053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 WELL BROOK CIRCLE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123873",
            "telephone_number": "770-922-3023",
            "fax_number": "770-929-1016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 WELL BROOK CIRCLE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123873",
            "telephone_number": "770-922-3023",
            "fax_number": "770-929-1016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENTREKIN",
        "first_name": "JOHN",
        "middle_name": "MANOR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2010-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "042565",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00754927A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

Verify at the official NPI Registry.