NPIMap

Individual provider Active NPI

Jorge B Pisarello, MD

  • Internal Medicine Physician
  • Dublin, GA
National Provider Identifier
1992795876
Registry record updated May 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
58914 Issued in GA
Practice address
107 Fairview Park Dr
Dublin, GA 31021-2501
Phone
(478) 864-3448
Fax
(478) 864-1288
NPI assigned
Oct 24, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician 2083P0011X MD027109E PA
Internal Medicine Physician 207R00000X 58914 GA Primary

Addresses

Primary practice location

107 Fairview Park Dr
Dublin, GA 31021-2501

Mailing address

PO Box 371
Wrightsville, GA 31096-0371
Phone (478) 864-3448

Other identifiers 3

IdentifierTypeStateIssuer
58914OtherGAMEDICAL LICENSE
1235131137OtherMIBCBSM - BLH
1992795876MedicaidMI

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
I20070409000466 GA Practitioner - Undersea and Hyperbaric MedicinePractitioner - Internal Medicine 8628017340 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Onesource Healthcare Group, LLC CurrentSince Apr 27, 2014 Accepting new patients
Community Health Care Systems, Inc CurrentSince Aug 11, 2014 Accepting new patients
Mky Healthcare Services LLC CurrentSince Apr 9, 2024 Accepting new patients
Community Health Care Systems, Inc. Current Accepting new patients
Onesource Healthcare Group, LLC CurrentSince Apr 27, 2014 Accepting new patients
Community Health Care Systems, Inc. CurrentSince Aug 11, 2014 Accepting new patients
Spectrum Health Hospitals Past Accepting new patients
Penn North Centers for Advanced Wound Care PC Undersea and Hyperbaric Medicine Past Accepting new patients
Kayenta Alternative Rural Hospital Past Accepting new patients
Davis L Kinney DC PC Past Accepting new patients

Locations

701 N Slappey Blvd
Albany, GA 31701
Phone (229) 435-4747

1107 Greer St
Ste E
Cordele, GA 31015
Phone (229) 273-0018

2010 Central Ave Ext
Ste F
Cordele, GA 31015
Phone (229) 273-2626

2010 Central Ave Ext
Cordele, GA 31015
Phone (229) 598-0595

107 Fairview Park Dr
Dublin, GA 31021
Phone (478) 272-3446

2251 W Elm St
Wrightsville, GA 31096
Phone (478) 864-2600

Interoperability endpoints

  • Direct secure messaging: jorge.pisarello.1@24536.direct.athenahealth.com

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431388800000",
    "number": "1992795876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 371",
            "city": "WRIGHTSVILLE",
            "state": "GA",
            "postal_code": "310960371",
            "telephone_number": "478-864-3448",
            "fax_number": "478-864-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 FAIRVIEW PARK DR",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310212501",
            "telephone_number": "478-864-3448",
            "fax_number": "478-864-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PISARELLO",
        "first_name": "JORGE",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2015-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "PA",
            "license": "MD027109E",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "58914",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "58914",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM - BLH",
            "identifier": "1235131137",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992795876",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dublin, GA

Sources for this page

Verify at the official NPI Registry.