Mohammad Ali Kukaswadia, MD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

043997 Issued in GA

Practice address

4904 Timber Ridge Drive
Suite 305
Douglasville, GA 30135

Phone

(678) 501-5420

Fax

(678) 501-5427

NPI assigned

Oct 25, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mohammad Ali Former name

Electronic endpoints 1

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

Specialty

NeurologyAlso: Internal Medicine

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northside Primary Care Professional Services,LLCGroup PAC ID 9638343924, 313 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Gwinnett Hospital, Lawrenceville, GA, CCN 110087
• Northside Hospital Duluth Hospital, Duluth, GA, CCN 110252
• Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005
• Northside Hospital Hospital, Atlanta, GA, CCN 110161

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mkukaswadia64077@directwellstar.org
• FHIR API: https://fhir4.healow.com/fhir/r4/JACJCA

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.

• Northside Primary Care Professional Services,LLC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1922397553
  Medicare reassignment Care Compare group NPD
• Kukaswadia P.C.

  • Neurology Physician
  • Douglasville, GA
  • NPI 1548573884
  NPD (past) Authorized official
• Northside Primary Care Professional Services, LLC

  • Urgent Care Clinic/Center
  • Dawsonville, GA
  • NPI 1215369715
  NPD
• Douglas Neurology Associates, P.C.

  • Neurology Physician
  • Douglasville, GA
  • NPI 1548300452
  NPD (past)
• Gwinnett Clinic LTD

  • Multi-Specialty Clinic/Center
  • Duluth, GA
  • NPI 1629117650
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Cumming, GA
  • NPI 1376574277
  Care Compare affiliation
• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1457396079
  Care Compare affiliation
• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Duluth, GA
  • NPI 1790715381
  Care Compare affiliation
• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Lawrenceville, GA
  • NPI 1952340994
  Care Compare affiliation

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600128000000",
    "number": "1043394109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "822 RIVERTON PARK PL SE",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301265685",
            "telephone_number": "678-501-5420",
            "fax_number": "678-501-5427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4904 TIMBER RIDGE DRIVE",
            "address_2": "SUITE 305",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "30135",
            "telephone_number": "678-501-5420",
            "fax_number": "678-501-5427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUKASWADIA",
        "first_name": "MOHAMMAD",
        "middle_name": "ALI",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "GEORGIA",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "043997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mohammad.kukaswadia.p2@direct.gmg.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "4904 TIMBER RIDGE DRIVE",
            "address_2": "SUITE 305",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30135",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MOHAMMAD",
            "last_name": "ALI",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lindsey Marie Krempa
• Sylvia Krow, LPC
• KTT Services
• Sierra Kucsera
• Kukaswadia P.C.
• Raju J Kulangara, MD
• Poonam Kumar
• Surender V Kumar, M.D.
• Veeni S Kumar, M.D.
• Lanalynne Ann Kurtzworth, RN

• Neurology Physician in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Neurology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.