Active NPI
Jodi McConnell
- Nurse Practitioner
- Ball Ground, GA
National Provider Identifier
1780182725
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- RN122137
- Practice address
- 115 Lathems Mill LN
Ball Ground, GA 30107-7906 - Phone
- (678) 595-7227
- NPI assigned
- Jan 24, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN122137 | GA | Primary |
Addresses
Primary practice location
115 Lathems Mill LN
Ball Ground, GA 30107-7906
Mailing address
115 Lathems Mill LN
Ball Ground, GA 30107-7906
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RN122137 | Other | GA | ADVANCED PRACTICE-NP |
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: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240112001818 | GA | Practitioner - Nurse Practitioner | 9335590462 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Emory University School of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northside Surgical Professional Services LLC
Practice addresses (Care Compare)
980 Sanders Rd
Suite 100
Cumming, GA 30041-5977
Phone (770) 866-1074
Hospital & facility affiliations
- Northside Hospital Forsyth
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northside Surgical Professional Services LLC | Current | Accepting new patients |
Locations
980 Sanders Rd
Ste 100
Cumming, GA 30041
Phone (770) 866-1074
1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737
1000 Johnson Fy Rd NE
Sandy Springs, GA 30342
Phone (404) 851-1000
Organizations & group practices 1
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 1
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": "1516752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516752000000",
"number": "1780182725",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 LATHEMS MILL LN",
"city": "BALL GROUND",
"state": "GA",
"postal_code": "301077906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 LATHEMS MILL LN",
"city": "BALL GROUND",
"state": "GA",
"postal_code": "301077906",
"telephone_number": "678-595-7227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCONNELL",
"first_name": "JODI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-01-24",
"last_updated": "2018-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "GA",
"license": "RN122137",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ADVANCED PRACTICE-NP",
"identifier": "RN122137",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ball Ground, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2018; 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.