Individual provider Active NPI

J. Mark Rheudasil, MD

  • Vascular Surgery Physician
  • Atlanta, GA
National Provider Identifier
1033184767
Registry record updated Sep 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
026926 Issued in GA
Practice address
5673 Peachtree Dunwoody Rd NE
Suite 675
Atlanta, GA 30342-1731
Phone
(678) 843-5400
Fax
(678) 843-5449
NPI assigned
Feb 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 026926 GA
Vascular Surgery Physician 2086S0129X 026926 GA Primary

Addresses

Primary practice location

5673 Peachtree Dunwoody Rd NE
Suite 675
Atlanta, GA 30342-1731

Mailing address

1838 American Way
Lawrenceville, GA 30043-6611
Phone (770) 995-7622

Other identifiers 11

IdentifierTypeStateIssuer
000635302MedicaidGA
000635302QMedicaidGA
000635302SMedicaidGA
000635302KMedicaidGA
000635302LMedicaidGA
000635302MMedicaidGA
000635302OMedicaidGA
000635302PMedicaidGA
000635302JMedicaidGA
000635302NMedicaidGA
000635302RMedicaidGA

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
I20101006000603 GA Practitioner - Vascular Surgery 3870785066 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of Texas Southwestern Medical School at Dallas, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Emory Clinic IncGroup PAC ID 8820901408, 3,507 clinicians

Practice addresses (Care Compare)

1365 Clifton Rd NE
Atlanta, GA 30322-1013
Phone (404) 778-7525

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.51 of 100Reported as apm
Quality
80.61
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal166

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emory Specialty Associates, LLC CurrentSince Jan 1, 2012 Accepting new patients
The Emory Clinic Inc Diagnostic Radiology CurrentSince Sep 1, 2014 Accepting new patients
St. Joseph'S Hospital Past Accepting new patients
Emory Health Care Past Accepting new patients
Saint Josephs Hospital of Atlanta Inc Past Accepting new patients
Northside Radiology Associates LLC Diagnostic Radiology PastSince Aug 1, 1996 Accepting new patients

Locations

1821 Clifton Rd NE
Atlanta, GA 30329
Phone (404) 728-6812

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

101 W Ponce de Leon Ave
Decatur, GA 30030
Phone (404) 778-4889

79 Southside Church St
Ellijay, GA 30540
Phone 7062764741457

5673 Peachtree Dunwoody Rd
Ste 320
Sandy Springs, GA 30342
Phone (404) 855-5660

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

5669 Ptree Dunwoody Rd NE
Sandy Springs, GA 30342
Phone (404) 252-8377

5669 Ptree Dunwoody Rd NE
Ste 100
Sandy Springs, GA 30342
Phone (404) 255-1161

5673 Peachtree Dunwoody Rd
Ste 675
Sandy Springs, GA 30342
Phone (678) 843-5400

Interoperability endpoints

  • Direct secure messaging: jrheudasil51807@direct.emory.org

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411430400000",
    "number": "1033184767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1838 AMERICAN WAY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300436611",
            "telephone_number": "770-995-7622",
            "fax_number": "770-995-7854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5673 PEACHTREE DUNWOODY RD NE",
            "address_2": "SUITE 675",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421731",
            "telephone_number": "678-843-5400",
            "fax_number": "678-843-5449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RHEUDASIL",
        "first_name": "J.",
        "middle_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2014-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "026926",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "GA",
            "license": "026926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000635302",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000635302Q",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000635302S",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000635302K",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000635302L",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000635302M",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000635302O",
            "state": "GA"
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            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000635302P",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000635302J",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000635302N",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000635302R",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.