NPIMap

Individual provider Active NPI

Jon Mallory McRae Jr., M.D.

  • Internal Medicine Physician
  • Bainbridge, GA
National Provider Identifier
1700890274
Registry record updated Mar 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
050218 Issued in GA
Practice address
1518 Miluli Ave
Bainbridge, GA 39819-4866
Phone
(229) 248-8500
Fax
(229) 248-8600
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 050218 GA Primary
Specialist 174400000X 050218 GA

Addresses

Primary practice location

1518 Miluli Ave
Bainbridge, GA 39819-4866

Mailing address

1518 Miluli Ave
Bainbridge, GA 39819-4866
Phone (229) 248-8500

Other identifiers 2

IdentifierTypeStateIssuer
000911842BMedicaidGA
00911842AMedicaidGA

Other names 1

  • Mallory McRae Professional name

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
I20040310000815 GA Practitioner - Internal Medicine 6002704327 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical College of Georgia School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Privia Medical Group of Georgia LLCGroup PAC ID 4284951542, 454 clinicians

Practice addresses (Care Compare)

101 Yorktown Dr
Fayetteville, GA 30214-1578

101 Yorktown Dr
Suite 100
Fayetteville, GA 30214-7663
Phone (770) 460-4285

1518 Miluli Ave
Bainbridge, GA 39819-4866
Phone (229) 248-8500

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Bainbridge, GA, CCN 117151
  • Archbold Home Health Services Home health agency, Thomasville, GA, CCN 117024
  • Georgia Hospice Care Hospice, Albany, GA, CCN 111773
  • Gentiva Hospice, Bainbridge, GA, CCN 111556
  • Memorial Hospital and Manor Hospital, Bainbridge, GA, CCN 110132
  • Donalsonville Hospital Inc Hospital, Donalsonville, GA, CCN 110194
  • Archbold Memorial Hospital Hospital, Thomasville, GA, CCN 110038
  • Southeast Health Medical Center Hospital, Dothan, AL, CCN 010001
  • Grady General Hospital Hospital, Cairo, GA, CCN 110121
  • Memorial Manor Nursing Home Nursing home, Bainbridge, GA, CCN 115711

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions56

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group of Georgia LLC Internal Medicine CurrentSince Apr 9, 2019 Accepting new patients
Privia Medical Group of Georgia LLC Internal Medicine CurrentSince Apr 9, 2019 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Georgi CurrentSince Jul 1, 2001 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County CurrentSince Jul 1, 2001 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

1518 Miluli Ave
Bainbridge, GA 39819
Phone (229) 248-8500

1500 E Shotwell St
Bainbridge, GA 39819
Phone (229) 243-6100

832 E Shotwell St
Bainbridge, GA 39819
Phone (229) 231-6146

101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
  • Direct secure messaging: mallory.mcrae.1@8042.direct.athenahealth.com

Organizations & group practices 5

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 11

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": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551916800000",
    "number": "1700890274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1518 MILULI AVE",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398194866",
            "telephone_number": "229-248-8500",
            "fax_number": "229-248-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1518 MILULI AVE",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398194866",
            "telephone_number": "229-248-8500",
            "fax_number": "229-248-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCRAE",
        "first_name": "JON",
        "middle_name": "MALLORY",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2019-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "050218",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "050218",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000911842B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00911842A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "MCRAE",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Bainbridge, GA

Sources for this page

Verify at the official NPI Registry.