Active NPI
John Nino, MD
- Otolaryngology Physician
- Douglasville, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 045901
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000799202A | Medicaid | GA |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Otolaryngology
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
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
- Wellstar Douglas Medical Center
- Wellstar Kennestone Regional Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.93 of 100
- 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
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellstar Medical Group, LLC | Current | Accepting new patients | |
| Wellstar Medical Group, LLC | Current | 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
- 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.
-
- Family Medicine Physician
- Kennesaw, GA
- NPI 1558664003
-
- Multi-Specialty Clinic/Center
- Marietta, GA
- NPI 1275992240
-
- Otolaryngology Physician
- Douglasville, GA
- NPI 1629399555
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Austell, GA
- NPI 1467420448
-
- General Acute Care Hospital
- Douglasville, GA
- NPI 1649247974
-
- General Acute Care Hospital
- Marietta, GA
- NPI 1649248626
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2011; 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.