NPIMap

Individual provider Active NPI

Nataliya Kubasova, MD

  • Family Medicine Physician
  • Monticello, GA
National Provider Identifier
1942563770
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11016443 Issued in IN
Practice address
898 College St
Monticello, GA 31064-1258
Phone
(706) 468-0988
Fax
(706) 468-6631
NPI assigned
Jun 18, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11016443 IN Primary

Addresses

Primary practice location

898 College St
Monticello, GA 31064-1258

Mailing address

898 College St
Monticello, GA 31064-1258
Phone (706) 468-0988

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jmhkubana@jmh.cernerdirect.com Direct
Direct Messaging Address JMHKUBANA@jmh.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150914002291 GA Practitioner - Family Practice 4486870433 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jasper Health Services Inc.Group PAC ID 7214901230, 8 clinicians

Practice addresses (Care Compare)

898 College St
Monticello, GA 31064-1258
Phone (706) 468-0988

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11016443INMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jasper Health Services, Inc. Family Medicine CurrentSince Jul 14, 2015 Accepting new patients
Jasper Health Services Inc. CurrentSince Jul 14, 2015 Accepting new patients
Jasper Health Services Inc. Past Accepting new patients

Locations

898 College St
Monticello, GA 31064
Phone (706) 468-0988

898 College St
#A
Monticello, GA 31064
Phone (706) 468-0988

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Jasper Memorial HospitalMonticello, GA, CCN 11Z303 Hospital W-2 Managing Employee Sep 7, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1942563770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "898 COLLEGE ST",
            "city": "MONTICELLO",
            "state": "GA",
            "postal_code": "310641258",
            "telephone_number": "706-468-0988",
            "fax_number": "706-468-6631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "898 COLLEGE ST",
            "city": "MONTICELLO",
            "state": "GA",
            "postal_code": "310641258",
            "telephone_number": "706-468-0988",
            "fax_number": "706-468-6631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBASOVA",
        "first_name": "NATALIYA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11016443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmhkubana@jmh.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "adt",
            "address_1": "898 College St",
            "city": "Monticello",
            "state": "GA",
            "country_code": "US",
            "postal_code": "310641258",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JMHKUBANA@jmh.cernerdirect.com",
            "affiliation": "N",
            "address_1": "898 College St",
            "city": "Monticello",
            "state": "GA",
            "country_code": "US",
            "postal_code": "310641258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Monticello, GA

Sources for this page

Verify at the official NPI Registry.