NPIMap

Organization Active NPI

Minaxi, LLC

  • Internal Medicine Physician
  • Martinez, GA
National Provider Identifier
1063872372
Registry record updated Feb 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MINAXI, LLC
Practice address
3524 Lost Tree CT
Martinez, GA 30907-9500
Phone
(706) 267-7681
NPI assigned
Feb 29, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2016

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

Authorized official

Name
Hetal Thakore, MDNPI 1821184540
Title
Owner
Phone
(706) 267-7681

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X GA
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

3524 Lost Tree CT
Martinez, GA 30907-9500

Mailing address

3524 Lost Tree CT
Martinez, GA 30907-9500
Phone (706) 267-7681

Other identifiers 1

IdentifierTypeStateIssuer
1821184540OtherGAINDIVIDUAL NPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160419000051 GA Part B Supplier - Clinic/Group Practice 0840598207 Receives reassigned benefits from 6 practitioners
Practice locations: Martinez, GA; Augusta, GA
O20170816003349 SC Part B Supplier - Clinic/Group Practice 0840598207 Receives reassigned benefits from 1 practitioner
Practice locations: North Augusta, SC

National Provider Directory

National Provider Directory
Tax ID family
Minaxi2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1537 Walton Way
Augusta, GA 30904
Phone (706) 721-1200

350 Austin Graybill Rd
North Augusta, SC 29860
Phone (706) 736-5244

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1456704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456704000000",
    "number": "1063872372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3524 LOST TREE CT",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309079500",
            "telephone_number": "706-267-7681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3524 LOST TREE CT",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309079500",
            "telephone_number": "706-267-7681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINAXI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-29",
        "last_updated": "2016-02-29",
        "status": "A",
        "authorized_official_last_name": "THAKORE",
        "authorized_official_first_name": "HETAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-267-7681",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1821184540",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinez, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.