Individual provider Active NPI

Robert Martin McKenna Jr., PA C

  • Medical Physician Assistant
  • Atlanta, GA
National Provider Identifier
1780620930
Registry record updated Aug 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
A676 Issued in SC
Practice address
5667 Peachtree Dunwoody Rd, NE
Suite 350
Atlanta, GA 30342-1725
Phone
(404) 252-7200
Fax
(404) 252-7397
NPI assigned
Jun 22, 2006
Last updated
Aug 12, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X A676 SC Primary

Addresses

Primary practice location

5667 Peachtree Dunwoody Rd, NE
Suite 350
Atlanta, GA 30342-1725

Mailing address

5667 Peachtree Dunwoody Rd, NE
Suite 350
Atlanta, GA 30342-1725
Phone (404) 252-7200

Other identifiers 1

IdentifierTypeStateIssuer
0033PAMedicaidSC

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081104000215 GA Practitioner - Physician Assistant 6103826086 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Emory Clinic IncGroup PAC ID 8820901408, 3,507 clinicians

Practice addresses (Care Compare)

1365 Clifton Rd NE
Atlanta, GA 30322-1013
Phone (404) 778-7525

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.51 of 100Reported as apm
Quality
80.61
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3534GAMDOther Technician
A676SCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Emory Clinic Inc CurrentSince Dec 10, 2014 Accepting new patients
Bestpractices of South Carolina, PC Past Accepting new patients
Musc Community Physicians Past Accepting new patients
Atlanta Pulmonary Group, LLC Past Accepting new patients
Critical Care Atlanta, LLC Past Accepting new patients
Palmetto Pulmonary Medicine. P.a. Past Accepting new patients
Beaufort Emergency Medicine, PA Past Accepting new patients

Locations

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

101 W Ponce de Leon Ave
Ste 300
Decatur, GA 30030
Phone (404) 778-4889

Interoperability endpoints

  • Direct secure messaging: rmckenna21454@direct.emory.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218499200000",
    "number": "1780620930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5667 PEACHTREE DUNWOODY RD, NE",
            "address_2": "SUITE 350",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421725",
            "telephone_number": "404-252-7200",
            "fax_number": "404-252-7397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5667 PEACHTREE DUNWOODY RD, NE",
            "address_2": "SUITE 350",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421725",
            "telephone_number": "404-252-7200",
            "fax_number": "404-252-7397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "ROBERT",
        "middle_name": "MARTIN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2008-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "A676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0033PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.