NPIMap

Individual provider Active NPI

John David Prologo, M.D.

  • Vascular & Interventional Radiology Physician
  • Atlanta, GA
National Provider Identifier
1558308379
Registry record updated Apr 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
72294 Issued in GA
Practice address
1364 Clifton Road NE
Suite D111
Atlanta, GA 30322
Phone
(404) 712-7033
Fax
(404) 712-7970
NPI assigned
Jun 1, 2006
Last updated
Apr 28, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X 72294 GA Primary

Addresses

Primary practice location

1364 Clifton Road NE
Suite D111
Atlanta, GA 30322

Mailing address

1364 Clifton Rd NE
Suite Ag05
Atlanta, GA 30322
Phone (404) 712-7033

Other identifiers 7

IdentifierTypeStateIssuer
9808106OtherOHAETNA
000000516404OtherOHANTHEM
000000230982OtherOHUNISON
389288OtherOHWELLCARE
2691823MedicaidOH
P00420609OtherOHRAILROAD MEDICARE
752765OtherOHBUCKEYE

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
I20140916001877 GA Practitioner - Interventional RadiologyPractitioner - Interventional Pain Management 7113924127 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional RadiologyAlso: Interventional Pain Management
Education
Ohio State University College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Emory Clinic IncGroup PAC ID 8820901408, 3,507 clinicians

Practice addresses (Care Compare)

1365 Clifton Rd NE
Atlanta, GA 30322-1013
Phone (404) 778-7525

2201 Henderson Mill Rd NE
Atlanta, GA 30345-2711

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.51 of 100Reported as apm
Quality
80.61
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emory Medical Care Foundation Inc Current Accepting new patients
Emory Medical Care Foundation Inc Vascular & Interventional Radiology CurrentSince Aug 1, 2014 Accepting new patients
The Emory Clinic Inc CurrentSince Aug 1, 2014 Accepting new patients
University Imaging Inc Past Accepting new patients

Locations

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

101 W Ponce de Leon Ave
Ste 300
Decatur, GA 30030
Phone (404) 778-4889

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430179200000",
    "number": "1558308379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1364 CLIFTON RD NE",
            "address_2": "SUITE AG05",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30322",
            "telephone_number": "404-712-7033",
            "fax_number": "404-712-7970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1364 CLIFTON ROAD NE",
            "address_2": "SUITE D111",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30322",
            "telephone_number": "404-712-7033",
            "fax_number": "404-712-7970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROLOGO",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2015-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "GA",
            "license": "72294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9808106",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000516404",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "000000230982",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "389288",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2691823",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00420609",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKEYE",
            "identifier": "752765",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.