Individual provider Active NPI

Mary John Ninan, M.D

  • Hematology & Oncology Physician
  • Johns Creek, GA
National Provider Identifier
1356533145
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
058551 Issued in GA
Practice address
6300 Hospital Pkwy Ste 300
Johns Creek, GA 30097-1982
Phone
(770) 623-8965
Fax
(770) 623-4018
NPI assigned
Aug 15, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Hematology & Oncology Physician 207RH0003X 058551 GA Primary
Hematology & Oncology Physician 207RH0003X 43128 TX
Hematology & Oncology Physician 207RH0003X N7955 TX

Addresses

Primary practice location

6300 Hospital Pkwy Ste 300
Johns Creek, GA 30097-1982

Mailing address

1835 Savoy Dr Ste 300
Atlanta, GA 30341-1071
Phone (678) 566-6995

Other identifiers 3

IdentifierTypeStateIssuer
G10127AOtherGAMEDICARE PTAN
003158193CMedicaidGA
003158193DMedicaidGA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mary.ninan.p1@direct.gacancer.nextgenshare.com Direct

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150209001303 GA Practitioner - Medical OncologyPractitioner - Hematology 7517081672 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Medical OncologyAlso: Hematology
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
NSH Cancer Institute Professional Services G LLCGroup PAC ID 0840443164, 115 clinicians

Practice addresses (Care Compare)

6300 Hospital Pkwy
Suite 300
Duluth, GA 30097-1982
Phone (770) 623-8965

Hospital & facility affiliations

  • Northside Hospital Hospital, Atlanta, GA, CCN 110161
  • Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005
  • Northside Hospital Cherokee Hospital, Canton, GA, CCN 110008
  • Northside Hospital Duluth Hospital, Duluth, GA, CCN 110252

Merit-based Incentive Payment System (MIPS)

Final score
71.19 of 100Reported as group
Quality
69.24
Improvement activities
40
Cost
51.37

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
N7955TXMDHematology & Oncology Physician
43128TXMDSpeech-Language Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
City of Hope Medical Group of Georgia LLC CurrentSince Sep 29, 2014 Accepting new patients
NSH Cancer Institute Professional Services G, LLC Hematology & Oncology CurrentSince Jan 7, 2019 Accepting new patients
NSH Cancer Institute Professional Services G LLC CurrentSince Jan 7, 2019 Accepting new patients
NSH Cancer Institute Professional Services G, LLC Hematology & Oncology Past Accepting new patients
Northside Imaging LLC Past Accepting new patients

Locations

3330 Preston Ridge Rd
Ste 110
Alpharetta, GA 30005
Phone (678) 566-6995

1835 Savoy Dr
Ste 300
Atlanta, GA 30341
Phone (678) 288-9555

6300 Hospital Pkwy
Ste 300
Johns Creek, GA 30097
Phone (770) 623-8965

600 Celebrate Life Pkwy
Newnan, GA 30265
Phone (404) 844-8334

1045 Southcrest Dr
Ste 200
Stockbridge, GA 30281
Phone (678) 289-0549

62742 Collections Ctr Dr
Chicago, IL 60693

Interoperability endpoints

  • Direct secure messaging: mary.ninan.p1@direct.gacancer.nextgenshare.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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1187136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1356533145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 SAVOY DR STE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303411071",
            "telephone_number": "678-566-6995",
            "fax_number": "678-566-0346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 HOSPITAL PKWY STE 300",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300971982",
            "telephone_number": "770-623-8965",
            "fax_number": "770-623-4018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NINAN",
        "first_name": "MARY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-15",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "GA",
            "license": "058551",
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "TX",
            "license": "43128",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "TX",
            "license": "N7955",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "G10127A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003158193C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003158193D",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mary.ninan.p1@direct.gacancer.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "6300 Hospital Pkwy Ste 300",
            "city": "Johns Creek",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300971982",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Johns Creek, GA

Sources for this page

Verify at the official NPI Registry.