NPIMap

Individual provider Active NPI

Nisreen A Jallad, M.D, FACC

  • Interventional Cardiology Physician
  • Warner Robins, GA
National Provider Identifier
1598943045
Registry record updated Jan 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
073857 Issued in GA
Practice address
1707 Watson Blvd
Warner Robins, GA 31093-3606
Phone
(478) 929-8030
Fax
(478) 929-8095
NPI assigned
Feb 7, 2008
Last updated
Jan 20, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X 073857 GA Primary

Addresses

Primary practice location

1707 Watson Blvd
Warner Robins, GA 31093-3606

Mailing address

1707 Watson Blvd
Warner Robins, GA 31093-3606
Phone (478) 929-8030

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
I20150727000744 GA Practitioner - Cardiovascular Disease (Cardiology) 5496941262 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Houston Hospitals IncGroup PAC ID 4284797580, 27 clinicians
Central Georgia Heart Institue, LLCGroup PAC ID 7315902087, 2 clinicians

Practice addresses (Care Compare)

1601 Watson Blvd
Warner Robins, GA 31093-3431
Phone (478) 922-4281

1707 Watson Blvd
Warner Robins, GA 31093-3606
Phone (478) 929-8030

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting26
Pacemaker insertion or repair1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
073857GAMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Georgia Heart Institue, LLC Cardiovascular Disease CurrentSince Jul 15, 2015 Accepting new patients
Central Georgia Vascular Solutions Interventional Cardiology CurrentSince Apr 1, 2020 Accepting new patients
Houston Hospitals Inc CurrentSince May 8, 2015 Accepting new patients
Houston Hospitals Inc Current Accepting new patients

Locations

3001 Palm Harbor Blvd
Ste A
Palm Harbor, FL 34683

688 Walnut St
Ste 201
Macon, GA 31201
Phone (478) 476-8692

1601 Watson Blvd
Warner Robins, GA 31093
Phone (478) 322-5155

1707 Watson Blvd
Warner Robins, GA 31093
Phone (478) 929-8030

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IBFHCA
  • FHIR API: https://fhir4.healow.com/fhir/r4/IBFHCA/Endpoint/IBFHCA

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 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": "1202342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579478400000",
    "number": "1598943045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 WATSON BLVD",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310933606",
            "telephone_number": "478-929-8030",
            "fax_number": "478-929-8095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 WATSON BLVD",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310933606",
            "telephone_number": "478-929-8030",
            "fax_number": "478-929-8095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JALLAD",
        "first_name": "NISREEN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D, FACC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-07",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "GA",
            "license": "073857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warner Robins, GA

Sources for this page

Verify at the official NPI Registry.