JACOB ALBERT MISENHEIMER (NPI# 1154564557) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154564557 |
| Entity Type | Individual |
| Full Name | JACOB ALBERT MISENHEIMER |
| Credential | M.D. |
| Practice Address |
1120 15th Street Augusta GA 30912-0004 |
| Mailing Address |
1499 Walton Way Ste. 1400 Augusta GA 30912-0004 |
| Practice Telephone | 7067212426 |
| Practice Fax Number | 7067212138 |
| Mailing Telephone | 7067246100 |
| Mailing Fax Number | 7067241600 |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2016-09-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 2015-00126 | NC | Allopathic & Osteopathic Physicians |
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
075732 | GA | Allopathic & Osteopathic Physicians |
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
075732 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
1120 15TH STREET |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30912-0004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447237375 | Ricardo Azziz | Obstetrics & Gynecology | 1120 15th Street, Augusta, GA 30912-0004 | 2005-12-30 |
| 1174094668 | Mary Gabrielle Helfgott | Advanced Practice Midwife | 1120 15th Street, Ba #7513, Augusta, GA 30912 | 2018-12-10 |
| 1912492471 | Sarah Crumley Asmann | Nurse Practitioner | 1120 15th Street, Department of Surgery, Augusta, GA 30912 | 2018-06-27 |
| 1912499286 | Jillian Marie Soto | Family Medicine | 1120 15th Street, Augusta, GA 30912 | 2018-06-03 |
| 1447740741 | Amanda Meredith Saxon | Nurse Practitioner | 1120 15th Street, Bbr 6518, Augusta, GA 30912 | 2018-05-14 |
| 1447757968 | Mohamed M Meghil | Student in an Organized Health Care Education/Training Program | 1120 15th Street, Gc-1337, Augusta, GA 30912 | 2018-04-11 |
| 1942721667 | Christopher Glen Jackson | Emergency Medicine | 1120 15th Street, Augusta, GA 30912 | 2017-07-03 |
| 1063933000 | Andrea Martinez-velez | Anesthesiology | 1120 15th Street, Augusta, GA 30912 | 2017-06-29 |
| 1063941409 | Viviam Skarleth Trejo | Surgery | 1120 15th Street, Augusta, GA 30912 | 2017-06-08 |
| 1548799976 | Alexander Herzog | Internal Medicine | 1120 15th Street, Augusta, GA 30912 | 2017-06-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548885940 | Hannah Gullickson Folsom | Family Medicine | 1459 Laney Walker Blvd Ae 3042, Augusta, GA 30912 | 2020-06-11 |
| 1487278909 | Robert Kennedy | Internal Medicine | Augusta University Internal Medicine Residency Program, 1120 15th Street, Bi 5070, Augusta, GA 30912 | 2020-06-01 |
| 1952968737 | Kayla M. Lasota | Pediatrics | 11230 115th St Ae3042, Augusta, GA 30912 | 2019-05-28 |
| 1003379280 | Kayla Cox | Internal Medicine | 1120 15th St Bi5070, Augusta, GA 30912 | 2019-04-13 |
| 1619435740 | Justin Ray Mackert | Student in an Organized Health Care Education/Training Program | Augusta University, 1120 15th Street, Gc 5110, Augusta, GA 30912 | 2019-03-07 |
| 1417444167 | Victor Celis | Dentist | John Wesley Gilbert Dr, Augusta, GA 30912 | 2018-04-18 |
| 1487157921 | Julie Ann Matsen | Student in an Organized Health Care Education/Training Program | 997 St. Sebastian Way, Eg-2021-10, Augusta Univ., Dept. of Psychiatry & Health Behavior, Augusta, GA 30912 | 2018-03-12 |
| 1497287031 | Luke Yuung-jier Chang | Ophthalmology | 1120 15th St # Ba2720, Augusta, GA 30912 | 2017-04-02 |
| 1821537622 | Lashawn Kay Boone | Nurse Practitioner | 1445 Harper St, Augusta, GA 30912 | 2017-02-14 |
| 1134675564 | Arnab Saha | Internal Medicine | 1120 15 Th St., Augusta, GA 30912 | 2016-08-26 |
| Find all providers in zip 30912 | ||||
| Taxonomy Code | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568894087 | Umg Vascular, LLC | Internal Medicine | 1350 Walton Way, Augusta, GA 30901-2612 | 2013-08-07 |
| 1316239346 | University Cardiology Associates LLC | Internal Medicine | 818 Saint Sebastian Way Ste 311, Augusta, GA 30901-2653 | 2011-05-10 |
| 1699067629 | University Cardiology Associates LLC | Internal Medicine | 1348 Walton Way Ste 5100, Augusta, GA 30901 | 2011-05-10 |
| 1902198369 | University Cardiology Associates LLC | Internal Medicine | 818 Saint Sebastian Way Ste 308, Augusta, GA 30901-2653 | 2011-05-04 |
| 1538371802 | Vishal Arora | Internal Medicine | 1120 15th St, Augusta, GA 30912-0004 | 2007-05-07 |
| 1871603134 | Deepak Kapoor | Internal Medicine | 1120 15th St, Augusta, GA 30912-0004 | 2006-08-30 |
| 1255313789 | Gordon Leslie Walters | Internal Medicine | 818 Saint Sebastian Way, Suite 311, Augusta, GA 30901-2651 | 2005-11-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669019394 | Champ Vascular, LLC | Internal Medicine | 1825 Highway 34 E Ste 3400, Newnan, GA 30265-6423 | 2019-12-02 |
| 1174006159 | Kendall M Griffith Md LLC | Internal Medicine | 1497 Fair Rd Ste 311, Statesboro, GA 30458-0828 | 2018-09-14 |
| 1558869826 | Coordinated Health of Ga, LLC | Internal Medicine | 10 Glenlake Pkwy Ste 130c, Atlanta, GA 30328-3495 | 2018-01-31 |
| 1447559604 | David Brendan Casey | Internal Medicine | 1700 Tree Ln Ste 100, Snellville, GA 30078-6749 | 2011-03-26 |
| 1730404120 | Deepali Nivas Tukaye | Internal Medicine | 1505 Northside Blvd Ste 3400, Cumming, GA 30041-8223 | 2010-03-29 |
| 1659560647 | Oduwole Organization Inc | Internal Medicine | 1415 Highway 85 N Ste 310-296, Fayetteville, GA 30214-7738 | 2007-10-16 |
| 1053487462 | Tiftarea Cardiology | Internal Medicine | 907 E. 18th St, Ste 100, Tifton, GA 31794 | 2006-11-28 |
| 1255412094 | Jeetendra B Patel | Internal Medicine | 1301 Sigman Rd Ne Ste 200, Conyers, GA 30012 | 2006-10-18 |
| 1811082605 | Cardiac Disease Specialists, PC | Internal Medicine | 296 Merchants Sq, Dallas, GA 30132-5029 | 2006-10-04 |
| 1770508756 | Hunt Dandridge Anderson | Internal Medicine | 4500 Hospital Blvd, Suite 230, Roswell, GA 30076-0003 | 2006-07-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.