Individual provider Active NPI

Jacob Alan Kirkpatrick

  • Pediatrics Physician
  • Macon, GA
National Provider Identifier
1609238989
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
009132 Issued in GA
Practice address
744 1St St
Macon, GA 31201-6840
Phone
(478) 633-7600
Fax
(478) 633-7354
NPI assigned
Mar 24, 2016
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 009132 GA Primary

Addresses

Primary practice location

744 1St St
Macon, GA 31201-6840

Mailing address

744 1St St
Macon, GA 31201-6840
Phone (478) 633-7600

Other practice location 1

1550 College St
Macon, GA 31207-1500
Phone (478) 301-2600

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200430002836 GA Practitioner - Pediatric Medicine 1850655549 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
009132GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Georgia Emergency Group, LLC CurrentSince Apr 1, 2020 Accepting new patients

Locations

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

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1458777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1609238989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 1ST ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312016840",
            "telephone_number": "478-633-7600",
            "fax_number": "478-633-7354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 1ST ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312016840",
            "telephone_number": "478-633-7600",
            "fax_number": "478-633-7354"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1550 College St",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312071500",
            "country_code": "US",
            "telephone_number": "478-301-2600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIRKPATRICK",
        "first_name": "JACOB",
        "middle_name": "ALAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-24",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "009132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.