Mary Kathryn Peabody, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

10377 Issued in GA

Practice address

10730 Medlock Bridge Rd
Johns Creek, GA 30097-2637

Phone

(404) 948-4073

NPI assigned

Apr 29, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Mary Kathryn Higgins Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Urology Institute of GeorgiaGroup PAC ID 1759552607, 57 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005

Merit-based Incentive Payment System (MIPS)

Final score

83.66 of 100Reported as group

Quality

69.85

Promoting interoperability

100

Improvement activities

40

Cost

75.7

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Advanced Urology Institute of Georgia

  • Urology Physician
  • Snellville, GA
  • NPI 1073896510
  Medicare reassignment Care Compare group
• Advanced Urology Institute of Georgia

  • Urology Physician
  • Decatur, GA
  • NPI 1134642200
  NPD
• Advanced Urology Institute of Georgia, PC

  • Urology Physician
  • Dallas, GA
  • NPI 1811846348
  NPD
• Advanced Urology Anesthesia, LLC

  • Anesthesiology Physician
  • Johns Creek, GA
  • NPI 1033662192
  NPD (past)
• Advanced Urology Institute of Georgia PC

  • Urology Physician
  • Conyers, GA
  • NPI 1790411585
  NPD (past)
• Urology Surgery Center Johns Creek LLC

  • Ambulatory Surgical Clinic/Center
  • Johns Creek, GA
  • NPI 1124571104
  NPD (past)

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

• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Cumming, GA
  • NPI 1376574277
  Care Compare affiliation

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

{
    "created_epoch": "1619654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670803200000",
    "number": "1609459577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 628231 MAIL CODE: 5068",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328628231",
            "telephone_number": "678-344-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10730 MEDLOCK BRIDGE RD",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300972637",
            "telephone_number": "404-948-4073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEABODY",
        "first_name": "MARY",
        "middle_name": "KATHRYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-29",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "10377",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "HIGGINS",
            "middle_name": "KATHRYN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Piyush C Patel, MD
• Renita Jain Patel, LPC
• Shrina Chandrakant Patel
• Patrick Edward Gilliland, LLC
• Terrah J Paul Olson, M.D.
• Leilani Peake
• Pear Pixels LLC
• Pediatric Dentistry of Johns Creek, LLC
• Per Badilika
• Mario Perazza, D.C.

• Surgical Physician Assistant in Johns Creek, GA
• Providers in Johns Creek, GA by specialty
• Surgical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.