Individual provider Active NPI

Haley B. Queen, PA

  • Medical Physician Assistant
  • Gainesville, GA
National Provider Identifier
1780989582
Registry record updated Jan 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
006086 Issued in GA
Practice address
743 Spring St NE
Gainesville, GA 30501
Phone
(770) 219-9000
NPI assigned
Jan 26, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X
Medical Physician Assistant 363AM0700X 006086 GA Primary

Addresses

Primary practice location

743 Spring St NE
Gainesville, GA 30501

Mailing address

PO Box 742616
Atlanta, GA 30374-2616
Phone (770) 219-8420

Other practice location 1

200 S. Enota Drive
Suite #380
Gainesville, GA 30501-3473
Phone (770) 219-7099

Other practice location 2

200 S. Enota Drive
Suite #380
Gainesville, GA 30501-3473
Phone (770) 219-7099

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hqueen29955@nghs.gadirect.net Direct

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
I20110527000349 GA Practitioner - Physician Assistant 2961689039 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

200 S Enota Dr NE
Gainesville, GA 30501-3466
Phone (770) 219-4000

597 S Enota Dr NE
Gainesville, GA 30501-2545
Phone (770) 219-7777

PO Box
Suite 1060
Oakwood, GA 30566-0018

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.83 of 100Reported as group
Quality
80.36
Promoting interoperability
100
Improvement activities
40
Cost
79.08

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Em-I Medical Services, LLC CurrentSince Aug 1, 2017 Accepting new patients

Locations

3651 Wheeler Rd
Augusta, GA 30909
Phone (706) 651-3232

5126 Hospital Dr NE
Covington, GA 30014
Phone (770) 385-4340

400 Charter Blvd
Macon, GA 31210
Phone (478) 757-6000

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.

Hospital & facility affiliations 2

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": "1296000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1780989582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742616",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742616",
            "telephone_number": "770-219-8420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "743 SPRING ST NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30501",
            "telephone_number": "770-219-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 S. Enota Drive",
            "address_2": "Suite #380",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013473",
            "country_code": "US",
            "telephone_number": "770-219-7099",
            "fax_number": "770-219-7923",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 S. Enota Drive",
            "address_2": "Suite #380",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013473",
            "country_code": "US",
            "telephone_number": "770-219-7099",
            "fax_number": "770-219-7923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "QUEEN",
        "first_name": "HALEY",
        "middle_name": "B.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-26",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "006086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hqueen29955@nghs.gadirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "743 Spring St NE",
            "city": "Gainesville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.