GODLY OBOMATE JACK MD
NPI 1114452588
Internal Medicine - Interventional Cardiology in Cartersville, GA
About Godly Obomate Jack Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GODLY OBOMATE JACK MD (NPI 1114452588) is an individual interventional cardiology provider in Cartersville, Georgia, licensed in Georgia (98756) and active in the NPI registry since April 2017. He is enrolled in Medicare PECOS, is affiliated with Piedmont Cartersville Medical Center, and is a graduate of Other (2017).
NPPES Registry Identity
Specialties & Licenses 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Godly Obomate Jack Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Godly Jack reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Rome, GA 30165
- Reassigned Medicare billing, Georgia enrollment
- 332 clinicians in this Medicare group
Albany, GA 31707
- Reassigned Medicare billing, Georgia enrollment
- Medicare enrollment name: Phoebe Physician Group Inc
- 1,118 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 11
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare 2
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Piedmont Cartersville Medical Center
Acute Care Hospitals · Cartersville, GAWellstar Cobb Medical Center
Acute Care Hospitals · Austell, GAPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30120 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Godly Jack's NPI number?
The NPI number for Godly Jack is 1114452588. It was assigned to this individual provider in the NPPES registry on April 24, 2017.
Where is Godly Jack located?
Godly Jack practices at 150 Gentilly Blvd, Cartersville, GA 30120. The listed phone number is (470) 490-6670.
What is Godly Jack's specialty?
The primary specialty registered for this NPI is Internal Medicine, specializing in Interventional Cardiology, with taxonomy code 207RI0011X.
Is Godly Jack enrolled in Medicare?
Yes. Godly Jack is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Godly Jack's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Godly Jack reassigns Medicare benefits to 2 organizations: Harbin Clinic, LLC (Rome, GA) and Phoebe Gastroenterology Associates (Albany, GA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Godly Jack's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Godly Jack accept?
Health plans from Alliant Health Plans, Inc., Oscar Health and Oscar Insurance Company list Godly Jack as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Godly Jack affiliated with any hospitals?
According to CMS data, Godly Jack is affiliated with Piedmont Cartersville Medical Center and Wellstar Cobb Medical Center.
When was this NPI record last updated?
The NPPES record for Godly Jack was last updated on June 20, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Godly Obomate Jack, MD · NPI 1114452588
Interventional Cardiology physician in Cartersville, Georgia. Individual provider, active in the CMS NPPES registry since April 24, 2017.
## Identity
- **NPI:** 1114452588 (Entity type: Individual)
- **Enumerated:** April 24, 2017
- **Primary specialty:** Internal Medicine - Interventional Cardiology · taxonomy 207RI0011X
- **State license:** 98756 (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 150 GENTILLY BLVD, Cartersville, GA 30120-8522
- **Phone:** (470) 490-6670 · **Fax:** (770) 382-5762
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Harbin Clinic, LLC (NPI 1679599088, Rome, GA); Phoebe Gastroenterology Associates (NPI 1659627131, Albany, GA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2017
## Record status
- **NPPES last updated:** June 20, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1114452588) · Data from the CMS NPPES public registry.