Jeanne L. Kopacka, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

002005 Issued in GA

Practice address

2000 Howard Farm Dr Ste 200
Cumming, GA 30041-6081

Phone

(770) 292-6500

Fax

(770) 292-6535

NPI assigned

Feb 22, 2006

Sex

Female

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21378/brand/1/csg/1/fhir/r4

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.

• Northside Surgical Professional Services LLC

  • Surgery Physician
  • Atlanta, GA
  • NPI 1356630990
  NPD (past)
• Perimeter Orthopaedics, P.C.

  • Orthopaedic Foot and Ankle Surgery Physician
  • Atlanta, GA
  • NPI 1275601171
  NPD (past)
• Resurgens, LLC

  • Orthopaedic Surgery Physician
  • Atlanta, GA
  • NPI 1386697928
  NPD (past)

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567036800000",
    "number": "1437124385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5671 PEACHTREE DUNWOODY RD NE",
            "address_2": "SUITE 700",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303425000",
            "telephone_number": "404-847-9999",
            "fax_number": "404-531-8466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 HOWARD FARM DR STE 200",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300416081",
            "telephone_number": "770-292-6500",
            "fax_number": "770-292-6535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPACKA",
        "first_name": "JEANNE",
        "middle_name": "L.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-22",
        "last_updated": "2019-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "002005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806351077B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806351077A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna Kolomitseva, LICENSED ND
• Jacqueline Komoroski, RN, IBCLC
• Kristina Konieczny
• Ansley Konkle, MS, CCC-SLP
• Grace Kim Koo, FNP-C
• Anna Kops
• Madhavi Kothapally
• Swachitha Kothapally, MD
• Alena Koval
• Susan Kramer, DMD

• Physician Assistant in Cumming, GA
• Providers in Cumming, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.