Individual provider Active NPI

Jessica Crabbe Harris, M.D.

  • Dermatology Physician
  • Marietta, GA
National Provider Identifier
1417360322
Registry record updated Jan 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
080310 Issued in GA
Practice address
111 Marble Mill Rd NW
Marietta, GA 30060-1047
Phone
(770) 422-1013
NPI assigned
Jun 9, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X LL36974 SC
Student in an Organized Health Care Education/Training Program 390200000X
Dermatology Physician 207N00000X 080310 GA Primary

Addresses

Primary practice location

111 Marble Mill Rd NW
Marietta, GA 30060-1047

Mailing address

111 Marble Mill Rd NW
Marietta, GA 30060-1047
Phone (770) 422-1013

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
I20181011001057 GA Practitioner - Dermatology 0749409894 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marietta Dermatology Associates PAGroup PAC ID 6507850120, 22 clinicians

Practice addresses (Care Compare)

5041 Dallas Hwy
Suite D
Powder Springs, GA 30127-6458
Phone (770) 422-1013

Merit-based Incentive Payment System (MIPS)

Final score
80.16 of 100Reported as individual
Quality
66.66
Promoting interoperability
95
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision11
Removal of skin lesions1274
Removal or shaving of skin growth1-10
Skin biopsy614

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Marietta Dermatology Associates PA Dermatology CurrentSince Jul 1, 2018 Accepting new patients

Locations

130 Oakside Ct
Ste A
Canton, GA 30114
Phone (770) 422-1013

840 Church St NE
Ste A1
Marietta, GA 30060
Phone (770) 428-5988

111 Marble Mill Rd NW
Marietta, GA 30060
Phone (770) 422-1013

5041 Dallas Hwy
Ste D
Powder Springs, GA 30127
Phone (770) 422-1013

5041 Dallas Hwy
Ste 209
Powder Springs, GA 30127

Interoperability endpoints

  • Direct secure messaging: jcharris@mariettaderm.emadirect.md

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1402272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547510400000",
    "number": "1417360322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 MARBLE MILL RD NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601047",
            "telephone_number": "770-422-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MARBLE MILL RD NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601047",
            "telephone_number": "770-422-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "JESSICA",
        "middle_name": "CRABBE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-09",
        "last_updated": "2019-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "LL36974",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "080310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.