NPIMap

Individual provider Active NPI

Ahmad Azmi Kabbani, MD

  • Nephrology Physician
  • Macon, GA
National Provider Identifier
1528328796
Registry record updated Jan 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
005444 Issued in GA
Practice address
640 Martin Luther King Jr Blvd Ste 200
Macon, GA 31201-3297
Phone
(478) 745-5455
Fax
(478) 745-2915
NPI assigned
May 22, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 005444 GA
Nephrology Physician 207RN0300X 005444 GA Primary

Addresses

Primary practice location

640 Martin Luther King Jr Blvd Ste 200
Macon, GA 31201-3297

Mailing address

640 Martin Luther King Jr Blvd Ste 200
Macon, GA 31201-3297
Phone (478) 745-5455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150824002574 GA Practitioner - Internal Medicine 2365608759 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Mercer University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Macon Medical Group PCGroup PAC ID 3173511334, 6 clinicians

Practice addresses (Care Compare)

640 Martin Luther King Jr Blvd
Suite 200
Macon, GA 31201-3297
Phone (478) 745-5455

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
37.79 of 100Reported as individual
Quality
30
Improvement activities
0
Cost
69.3

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
005444GAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Macon Medical Group PC Nephrology CurrentSince Jul 1, 2018 Accepting new patients

Locations

640 Mlk Blvd
Ste 200
Macon, GA 31201
Phone (478) 745-5455

777 Hemlock St
#69
Macon, GA 31201
Phone (478) 633-1700

777 Hemlock St
Macon, GA 31201
Phone (478) 474-5600

309 Osigian Blvd
Warner Robins, GA 31088
Phone (478) 745-5455

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1528328796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 MARTIN LUTHER KING JR BLVD STE 200",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312013297",
            "telephone_number": "478-745-5455",
            "fax_number": "478-745-3915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 MARTIN LUTHER KING JR BLVD STE 200",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312013297",
            "telephone_number": "478-745-5455",
            "fax_number": "478-745-2915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KABBANI",
        "first_name": "AHMAD",
        "middle_name": "AZMI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-22",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "005444",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "005444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.