Individual provider Active NPI

Hyo Jin Song, MD

  • Clinical Cardiac Electrophysiology Physician
  • Cumming, GA
National Provider Identifier
1861771701
Registry record updated Feb 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
83299 Issued in GA
Practice address
1505 Northside Blvd Ste 3600
Cumming, GA 30041-8245
Phone
(770) 343-8565
Fax
(770) 781-3559
NPI assigned
Aug 9, 2011
Last updated
Feb 26, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Cardiovascular Disease Physician 207RC0000X 83299 GA
Clinical Cardiac Electrophysiology Physician 207RC0001X 83299 GA Primary

Addresses

Primary practice location

1505 Northside Blvd Ste 3600
Cumming, GA 30041-8245

Mailing address

8700 Beverly Blvd # B112
West Hollywood, CA 90048-1804
Phone (310) 423-5161

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address NorthsideHeart@Northside.gwaydirect.com 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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190801003454 GA Practitioner - Cardiovascular Disease (Cardiology) 0244555621 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Medical College of Georgia School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northside Cardiovascular Professional Services, LLCGroup PAC ID 9739189838, 143 clinicians

Practice addresses (Care Compare)

1000 Johnson Ferry Rd NE
Atlanta, GA 30342-1606
Phone (404) 851-8000

1000 Medical Ctr Blvd
Lawrenceville, GA 30046-7694
Phone (678) 312-1000

1200 Northside Forsyth Dr
Cumming, GA 30041-7659
Phone (770) 844-3200

1285 Upper Hembree Rd
Roswell, GA 30076-1143
Phone (770) 343-8565

2000 Howard Farm Dr
Suite 450
Cumming, GA 30041-6085
Phone (404) 962-6000

450 Northside Cherokee Blvd
Canton, GA 30115-8015
Phone (770) 224-1000

470 Northside Cherokee Blvd
Canton, GA 30115-8029

5670 Peachtree Dunwoody Rd
Suite 880
Atlanta, GA 30342-4789
Phone (404) 256-2525

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.82 of 100Reported as group
Quality
67.82
Promoting interoperability
77
Improvement activities
40
Cost
77.43

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
83299GAMDClinical Cardiac Electrophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Cardiovascular Professional Services, LLC Cardiovascular Disease CurrentSince Jul 1, 2019 Accepting new patients
Cedars Sinai Past Accepting new patients

Locations

3400 Old Milton Pkwy
Ste C360
Alpharetta, GA 30005
Phone (770) 442-1200

1110 W Peachtree St NW
Ste 920
Atlanta, GA 30309

550 Peachtree St NE
Ste 1550
Atlanta, GA 30308
Phone (404) 892-2131

460 Northside Cherokee Blvd
Ste 190
Canton, GA 30115
Phone (470) 639-6250

1505 Northside Blvd
Ste 3600
Cumming, GA 30041
Phone (470) 639-6272

2000 Howard Farm Dr
Ste 450
Cumming, GA 30041
Phone (901) 489-4991

7823 Spivey Station Blvd
Ste 310
Jonesboro, GA 30236
Phone (770) 989-6112

1285 Upper Hembree Rd
Roswell, GA 30076
Phone (770) 343-8565

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

6135 Barfield Rd
Ste 200
Sandy Springs, GA 30328
Phone (404) 256-8500

900 Towne Lake Pkwy
Ste 400
Woodstock, GA 30189
Phone (770) 721-3975

Organizations & group practices 2

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 4

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": "1312848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1861771701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8700 BEVERLY BLVD # B112",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900481804",
            "telephone_number": "310-423-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 NORTHSIDE BLVD STE 3600",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300418245",
            "telephone_number": "770-343-8565",
            "fax_number": "770-781-3559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "HYO JIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-09",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "83299",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "GA",
            "license": "83299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "NorthsideHeart@Northside.gwaydirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "1505 Northside Blvd Ste 3600",
            "city": "Cumming",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300418245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.