Jaza Monique Marina, MD

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

055267 Issued in GA

Practice address

2525 Cumberland Parkway
Kaiser Permanente Cumberland Medical Center
Atlanta, GA 30339

Phone

(770) 431-4107

Fax

(770) 431-4373

NPI assigned

Aug 31, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Jaza Marina Former name

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956
  Medicare reassignment NPD

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648512000000",
    "number": "1508977299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT RD, NE",
            "address_2": "NINE PIEDMONT CENTER",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30305",
            "telephone_number": "404-364-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 CUMBERLAND PARKWAY",
            "address_2": "KAISER PERMANENTE CUMBERLAND MEDICAL CENTER",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30339",
            "telephone_number": "770-431-4107",
            "fax_number": "770-431-4373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARINA",
        "first_name": "JAZA",
        "middle_name": "MONIQUE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "055267",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "GA",
            "license": "055267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - EAMC",
            "identifier": "387570",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - BCPHC",
            "identifier": "783527",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "389254619C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "389254619A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2525 Cumberland Parkway",
            "address_2": "Kaiser Permanente Cumberland Medical Center",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JAZA",
            "last_name": "MARINA",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rhoda Margolis, LCSW
• Anthony John Mari, DC
• Marigold Physical Therapy, LLC
• Marigold Therapy, LLC
• Terri Marin, NNP
• Christopher David Marine, M.D.
• Hallie Lin Marino, APRN CNS
• Mario Eurico Ravry, M.D.
• Mario Ravry, M.D., LLC
• Marion & Associates Family Care

• Geriatric Medicine (Internal Medicine) Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Geriatric Medicine (Internal Medicine) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.