Jae H Pak, M.D.

Primary specialty

Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X

License

040185 Issued in GA

Practice address

2160 Fountain Dr
Suite 200
Snellville, GA 30078-7022

Phone

(770) 982-1111

Fax

(770) 982-7280

NPI assigned

Jul 22, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Specialty

PsychiatryAlso: Geriatric Psychiatry

Education

Medical College of Georgia School of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jody Amazon PCGroup PAC ID 2466866322, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Interim Healthcare of Atlanta Inc Home health agency, Atlanta, GA, CCN 117067
• Piedmont Athens Regional Medical Center Hospital, Athens, GA, CCN 110074
• Piedmont Eastside Medical Center Hospital, Snellville, GA, CCN 110192
• Piedmont Hospital, Inc Hospital, Atlanta, GA, CCN 110083

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jaepak@hfs.allscriptsdirect.net

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.

• Jae Pak PC

  • Geriatric Psychiatry Physician
  • Snellville, GA
  • NPI 1184706996
  Medicare reassignment NPD Authorized official
• Jody Amazon PC

  • Geriatric Psychiatry Physician
  • Snellville, GA
  • NPI 1396334330
  NPD
• Eastside Medical Center, LLC

  • General Acute Care Hospital
  • Snellville, GA
  • NPI 1467406132
  NPD (past)
• Gary S Figiel MD PC

  • Geriatric Psychiatry Physician
  • Atlanta, GA
  • NPI 1265591754
  NPD (past)
• Greater Gwinnett Physician Practice Company

  • Family Medicine Physician
  • Lilburn, GA
  • NPI 1891737425
  NPD (past)
• Uhs of Summitridge, LLC

  • Psychiatric Hospital
  • Lawrenceville, GA
  • NPI 1407021546
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Eastside Medical Center, LLC

  • General Acute Care Hospital
  • Snellville, GA
  • NPI 1467406132
  Care Compare affiliation
• Piedmont Athens Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Athens, GA
  • NPI 1437186111
  Care Compare affiliation
• Piedmont Hospital, Inc

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1962461681
  Care Compare affiliation
• STG Healthcare of Atlanta, Inc.

  • Home Health Agency
  • Atlanta, GA
  • NPI 1952337214
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464912000000",
    "number": "1740280551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 FOUNTAIN DR",
            "address_2": "SUITE 200",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300787022",
            "telephone_number": "770-982-1111",
            "fax_number": "770-982-7280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 FOUNTAIN DR",
            "address_2": "SUITE 200",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300787022",
            "telephone_number": "770-982-1111",
            "fax_number": "770-982-7280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAK",
        "first_name": "JAE",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-22",
        "last_updated": "2016-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "GA",
            "license": "040185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "10594474",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000678477E",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "26BDJZQ",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Psychiatry Physician in Snellville, GA
• Providers in Snellville, GA by specialty
• Geriatric Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2016; 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.

Verify at the official NPI Registry.