Individual provider Active NPI

John Nino, MD

  • Otolaryngology Physician
  • Douglasville, GA
National Provider Identifier
1689670804
Registry record updated Jun 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
045901 Issued in GA
Practice address
6002 Professional Pkwy
Suite 100
Douglasville, GA 30134-5600
Phone
(770) 949-4200
Fax
(770) 949-5553
NPI assigned
Jun 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 045901 GA Primary

Addresses

Primary practice location

6002 Professional Pkwy
Suite 100
Douglasville, GA 30134-5600

Mailing address

6002 Professional Pkwy
Suite 100
Douglasville, GA 30134-5600
Phone (770) 949-4200

Other identifiers 1

IdentifierTypeStateIssuer
000799202AMedicaidGA

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
I20091204000147 GA Practitioner - OtolaryngologyPractitioner - Internal Medicine 3779622766 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

1790 Mulkey Rd
Austell, GA 30106-1122

3950 Austell Rd
Austell, GA 30106-1121
Phone (770) 732-4022

4441 Atlanta Rd SE
Suite 204
Smyrna, GA 30080-6442
Phone (470) 610-0145

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

6002 Professional Pkwy
Suite 100
Douglasville, GA 30134-5603
Phone (770) 949-4200

8954 Hospital Dr
Douglasville, GA 30134-2272
Phone (678) 838-2585

Hospital & facility affiliations

  • Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143
  • Wellstar Douglas Medical Center Hospital, Douglasville, GA, CCN 110184
  • Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Mar 1, 2011 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Mar 1, 2011 Accepting new patients
Wellstar Bi-County ENT, LLC Otolaryngology Past Accepting new patients

Locations

1790 Mulkey Rd
Ste 7
Austell, GA 30106
Phone (770) 819-1435

6002 Professional Pkwy
Ste 100
Douglasville, GA 30134
Phone (770) 949-4200

5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

805 Sandy Plains Rd
Marietta, GA 30066
Phone (770) 792-1616

4441 Atlanta Rd SE
Ste 205
Smyrna, GA 30080
Phone (770) 801-5020

Interoperability endpoints

  • Direct secure messaging: jnino25450@directwellstar.org

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 3

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": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309392000000",
    "number": "1689670804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6002 PROFESSIONAL PKWY",
            "address_2": "SUITE 100",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301345600",
            "telephone_number": "770-949-4200",
            "fax_number": "770-949-5553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6002 PROFESSIONAL PKWY",
            "address_2": "SUITE 100",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301345600",
            "telephone_number": "770-949-4200",
            "fax_number": "770-949-5553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NINO",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2011-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "045901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000799202A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglasville, GA

Sources for this page

Verify at the official NPI Registry.