NPIMap

Individual provider Active NPI

Kathryn Elaine Herndon, M.D

  • Interventional Pain Medicine Physician
  • Gainesville, GA
National Provider Identifier
1679567150
Registry record updated Oct 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
032749 Issued in GA
Practice address
530 Spring St SE
Gainesville, GA 30501-3740
Phone
(770) 503-7222
Fax
(770) 718-0009
NPI assigned
Sep 9, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 03279 GA
Pain Medicine (Anesthesiology) Physician 207LP2900X 032749 GA
Interventional Pain Medicine Physician 208VP0014X 032749 GA Primary

Addresses

Primary practice location

530 Spring St SE
Gainesville, GA 30501-3740

Mailing address

530 Spring St SE
Gainesville, GA 30501-3740
Phone (770) 503-7222

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
I20040716001162 GA Practitioner - Interventional Pain Management 5193704724 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Pain Management
Education
Emory University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Georgialina Physical Therapy Associates LLCGroup PAC ID 6002812401, 406 clinicians

Practice addresses (Care Compare)

1321 Interstate Pkwy
Augusta, GA 30909-5626
Phone (706) 945-0810

530 Spring St SE
Gainesville, GA 30501-3740
Phone 770503722210

Hospital & facility affiliations

  • Accentcare Home Health of Northeast Georgia Home health agency, Buford, GA, CCN 117139
  • Affinis Hospice, LLC- Gainesville Hospice, Gainesville, GA, CCN 111719
  • Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005
  • Northeast Georgia Medical Center, Inc Hospital, Gainesville, GA, CCN 110029
  • Northeast Georgia Medical Center Habersham Hospital, Demorest, GA, CCN 110041
  • Northside Hospital Hospital, Atlanta, GA, CCN 110161

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
03279GAMDSpecialist
032749GAMDPain Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Georiga Pain Management & Diagnostics, LLC Specialist CurrentSince Jul 5, 2004 Accepting new patients

Locations

530 Spring St SE
Gainesville, GA 30501
Phone (770) 503-7222

Interoperability endpoints

  • Direct secure messaging: kathryn.herndon@gpmd.gadirect.net

Organizations & group practices 3

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 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": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666483200000",
    "number": "1679567150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 SPRING ST SE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013740",
            "telephone_number": "770-503-7222",
            "fax_number": "770-718-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 SPRING ST SE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013740",
            "telephone_number": "770-503-7222",
            "fax_number": "770-718-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNDON",
        "first_name": "KATHRYN",
        "middle_name": "ELAINE",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-09",
        "last_updated": "2022-10-23",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "03279",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "GA",
            "license": "032749",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "GA",
            "license": "032749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.