Jack Anthony Miceli, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN242971 Issued in GA

Practice address

1825 Martha Berry Blvd NW
Rome, GA 30165-1625

Phone

(762) 235-1470

Fax

(706) 238-8081

NPI assigned

Mar 5, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Harbin Clinic LLCGroup PAC ID 0446154231, 238 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Atrium Health Floyd Medical Center Hospital, Rome, GA, CCN 110054

Merit-based Incentive Payment System (MIPS)

Final score

83.23 of 100Reported as group

Quality

65.74

Promoting interoperability

100

Improvement activities

40

Cost

78.37

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jack.miceli.1@1498.direct.athenahealth.com
• Direct secure messaging: jmiceli3004788@carolinashealthcaresystem.direct-ci.com

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.

• Harbin Clinic, LLC

  • Multi-Specialty Clinic/Center
  • Rome, GA
  • NPI 1679599088
  Medicare reassignment Care Compare group NPD
• Harbin Clinic, LLC

  • Ambulatory Surgical Clinic/Center
  • Rome, GA
  • NPI 1447385158
  NPD
• Harbin Clinic, LLC

  • Ambulatory Surgical Clinic/Center
  • Cartersville, GA
  • NPI 1467016055
  NPD

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

• Floyd Healthcare Management Inc

  • General Acute Care Hospital
  • Rome, GA
  • NPI 1154377166
  Care Compare affiliation

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

{
    "created_epoch": "1583366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1821623232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 TECHNOLOGY PKWY NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651369",
            "telephone_number": "762-235-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 MARTHA BERRY BLVD NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651625",
            "telephone_number": "762-235-1470",
            "fax_number": "706-238-8081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICELI",
        "first_name": "JACK",
        "middle_name": "ANTHONY",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-05",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN242971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jack.miceli.1@1498.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "5470 Martha Berry Hwy NE",
            "city": "Armuchee",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301052302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christine Elizabeth Meyer, PA-C
• Margaret Elanie Meyers
• Maria Virginia Meyers, PA-C
• Rita Saveria Mezzatesta, MD
• MH Dental P.C.
• Michael S. Jackson, MD, PC
• Dawne R Michael, MSN, AGPCNP-C
• Mitzie Marion Colet Mickelson, OTR/L, CPAM
• Brian Middleton, DPM
• Matthew David Middleton, PHARMD

• Nurse Practitioner in Rome, GA
• Providers in Rome, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; 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.