NPIMap

Individual provider Active NPI

Andre M Kallab, M.D.

  • Hematology & Oncology Physician
  • Gainesville, GA
National Provider Identifier
1669475760
Registry record updated Sep 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
45259 Issued in GA
Practice address
1240 Jesse Jewell Pkwy SE
Ste 500
Gainesville, GA 30501-3861
Phone
(770) 287-0031
Fax
(770) 297-5034
NPI assigned
May 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 45259 GA Primary

Addresses

Primary practice location

1240 Jesse Jewell Pkwy SE
Ste 500
Gainesville, GA 30501-3861

Mailing address

1240 Jesse Jewell Pkwy SE
Suite 600
Gainesville, GA 30501-3862
Phone (770) 536-9864

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address andrekallab@negaidx.allscriptsdirect.net Direct

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
I20050527000704 GA Practitioner - Hematology/Oncology 0244272383 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Georgia Diagnostic Associates and Clinic, LLCGroup PAC ID 1951655737, 81 clinicians

Practice addresses (Care Compare)

1240 Jesse Fewell Pkwy SE
Suite 500
Gainesville, GA 30501-3861
Phone (770) 536-9864

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.26 of 100Reported as group
Quality
71.9
Promoting interoperability
75
Improvement activities
40
Cost
76.47

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
45259GAMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Georgia Diagnostic Associates and Clinic, LLC CurrentSince Oct 1, 2018 Accepting new patients

Locations

1240 Jesse Jewell Pkwy SE
Ste 600
Gainesville, GA 30501
Phone (770) 287-0031

1240 Jesse Jewell Pkwy SE
Ste 500
Gainesville, GA 30501

1250 Jesse Jewell Pkwy SE
Ste 400
Gainesville, GA 30501
Phone (470) 228-7507

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 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": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600041600000",
    "number": "1669475760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 JESSE JEWELL PKWY SE",
            "address_2": "SUITE 600",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013862",
            "telephone_number": "770-536-9864",
            "fax_number": "770-297-5034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 JESSE JEWELL PKWY SE",
            "address_2": "STE 500",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013861",
            "telephone_number": "770-287-0031",
            "fax_number": "770-297-5034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLAB",
        "first_name": "ANDRE",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "GA",
            "license": "45259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "andrekallab@negaidx.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "1240 Jesse Jewell Pkwy SE",
            "address_2": "Ste 500",
            "city": "Gainesville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "305013861",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.