Kennon Howard McCollum, MSN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN102128 Issued in GA

Practice address

1045 Southcrest Dr
Suite 200
Stockbridge, GA 30281-6113

Phone

(678) 289-0549

Fax

(678) 289-8756

NPI assigned

Jan 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

NSH Cancer Institute Professional Services G LLCGroup PAC ID 0840443164, 115 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Hospital, Atlanta, GA, CCN 110161

Merit-based Incentive Payment System (MIPS)

Final score

71.19 of 100Reported as group

Quality

69.24

Improvement activities

40

Cost

51.37

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

Practice roles

Locations

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.

• NSH Cancer Institute Professional Services G, LLC

  • Hematology & Oncology Physician
  • Sandy Springs, GA
  • NPI 1144571381
  Medicare reassignment Care Compare group NPD
• NSH Cancer Institute Professional Services G LLC

  • Durable Medical Equipment & Medical Supplies
  • Blue Ridge, GA
  • NPI 1629329792
  NPD
• Northside Hospital, Inc.

  • Community/Retail Pharmacy
  • Atlanta, GA
  • NPI 1073572723
  NPD (past)
• Northside Imaging LLC

  • Diagnostic Radiology Physician
  • Warner Robins, GA
  • NPI 1316394976
  NPD (past)
• NSH Cancer Institute Professional Services G, LLC

  • Hematology & Oncology Physician
  • Atlanta, GA
  • NPI 1124379284
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1457396079
  Care Compare affiliation

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

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1427036409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 SAVOY DR",
            "address_2": "SUITE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303411072",
            "telephone_number": "678-289-0549",
            "fax_number": "678-289-8756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 SOUTHCREST DR",
            "address_2": "SUITE 200",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816113",
            "telephone_number": "678-289-0549",
            "fax_number": "678-289-8756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOLLUM",
        "first_name": "KENNON",
        "middle_name": "HOWARD",
        "name_prefix": "Mr.",
        "credential": "MSN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-09",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN102128",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000968745J",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000968745K",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000968745H",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kennon.mccollumaprnbc.p1@direct.gacancer.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "1045 Southcrest Dr",
            "address_2": "Suite 200",
            "city": "Stockbridge",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302816113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ashlee Nicole Mayberry-Marshall, LPC
• Karaven Mayfield
• Shannon Mayfield, CNM
• Mba Wellness Centers
• Francis L McCafferty Jr., MD
• Michael E McConnell, M.D.
• Ashlee McCorkle-Jamieson, M.D.
• Tameka McCrae - Edgecombe, LPC
• Selina Marie McCray, LPC
• Simone McCray, NP

• Nurse Practitioner in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.