NPIMap

Individual provider Active NPI

Israel J Cabanas Jr.

  • Family Medicine Physician
  • Stone Mountain, GA
National Provider Identifier
1407911647
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
037769 Issued in GA
Practice address
5462 Memorial Dr
Suite 202
Stone Mountain, GA 30083-3239
Phone
(404) 292-5676
Fax
(404) 299-8657
NPI assigned
Dec 27, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 037769 GA Primary

Addresses

Primary practice location

5462 Memorial Dr
Suite 202
Stone Mountain, GA 30083-3239

Mailing address

5462 Memorial Dr
Suite 202
Stone Mountain, GA 30083-3239
Phone (404) 292-5676

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
I20090122000313 GA Practitioner - Family Practice 3678637550 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emory Specialty Associates, LLCGroup PAC ID 3476559782, 706 clinicians

Practice addresses (Care Compare)

1821 Clifton Rd NE
Atlanta, GA 30329-4021
Phone (404) 728-6812

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.51 of 100Reported as apm
Quality
80.61
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
037769GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emory Specialty Associates, LLC Family Medicine CurrentSince Aug 27, 2022 Accepting new patients
Dekalb Family Practice, P.C. Family Medicine PastSince Jan 1, 2007 Accepting new patients

Locations

1776 Old Spring House Ln
Atlanta, GA 30338
Phone (770) 454-0091

1821 Clifton Rd NE
Atlanta, GA 30329
Phone (404) 728-6812

2201 Henderson Mill Rd NE
Ste 160
Atlanta, GA 30345
Phone (404) 251-2193

5462 Memorial Dr
Stone Mtn, GA 30083
Phone (404) 292-5676

5462 Memorial Dr
Ste 202
Stone Mtn, GA 30083
Phone (404) 292-4057

Interoperability endpoints

  • Direct secure messaging: icabanas59887@direct.emory.org

Organizations & group practices 2

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 8

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": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407911647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5462 MEMORIAL DR",
            "address_2": "SUITE 202",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833239",
            "telephone_number": "404-292-5676",
            "fax_number": "404-299-8657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5462 MEMORIAL DR",
            "address_2": "SUITE 202",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833239",
            "telephone_number": "404-292-5676",
            "fax_number": "404-299-8657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CABANAS",
        "first_name": "ISRAEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "037769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stone Mountain, GA

Sources for this page

Verify at the official NPI Registry.