Jensine Tomi Chemmalakuzhy, NP – Nurse Practitioner

Key facts

NPI: 1497350920
Entity type: Individual (NPI type 1)
Primary specialty: Nurse Practitioner 363L00000X
License: RN252456 (GA)
Practice address: 1010 Park Dr
Greensboro, GA 30642-3466
Phone: (706) 227-7850
NPI assigned: Dec 2, 2020
Sex: Female
Sole proprietor: No

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.

Piedmont Cardiology of Atlanta, LLC Cardiovascular Disease Physician · Atlanta, GA · NPI 1275729691

Medicare reassignment Care Compare group NPD GA

Hospital & facility affiliations 1

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

Piedmont Rockdale Hospital Inc. General Acute Care Hospital · Conyers, GA · NPI 1306355680

Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty: Nurse Practitioner
Education: Emory University School of Medicine, 2020
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Piedmont Cardiology of Atlanta, LLC (478 clinicians)

Practice addresses (Care Compare)

1412 Milstead Ave NE
Conyers, GA 30012-3877
Phone (770) 918-3000

Hospital & facility affiliations

Piedmont Rockdale Hospital Hospital · Conyers, GA · CCN 110091

Merit-based Incentive Payment System (MIPS)

Final score: 91.62 of 100 (apm)
Quality: 83.25
Promoting interoperability: 100
Improvement activities: 40

Medicare participation

Medicare fee-for-service enrollment: Enrolled in GA
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20210218001149	GA	Practitioner - Nurse Practitioner	1951716216	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Nurse Practitioner

State licenses

License	State	Type	Specialty
RN252456	GA	MD	Nurse Practitioner

Practice roles

Organization	Specialty	Status	New patients
Piedmont Cardiology of Atlanta, LLC		Current since Mar 1, 2021	Accepting new patients

Locations

2727 Paces Ferry Rd SE
Ste 1-1100
Atlanta, GA 30339
Phone (470) 271-3421

1412 Milstead Ave NE
Conyers, GA 30012
Phone (770) 918-3000

1010 Park Dr
Greensboro, GA 30642
Phone (706) 227-7850

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Nurse Practitioner	363L00000X	RN252456	GA	Yes
Registered Nurse	163W00000X	RN252456	GA

Addresses

Primary practice location

1010 Park Dr
Greensboro, GA 30642-3466

Mailing address

PO Box 116116
Atlanta, GA 30368-6116

Other names

Jensine Illikattil Tomi Former name

Other providers in Greensboro, GA

All providers in Greensboro, GA · Nurse Practitioner in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2021. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (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.