Khushbu Modi

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

RN202188 Issued in GA

Practice address

276 Harmony Lake Dr
Canton, GA 30115-4781

Phone

(404) 488-5590

NPI assigned

Nov 3, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Group practices

Mak Anesthesia Holdings, LLCGroup PAC ID 4284917204, 370 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellstar North Fulton Medical Center Hospital, Roswell, GA, CCN 110198

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Mak Anesthesia Holdings LLC

  • Anesthesiology Physician
  • Kennesaw, GA
  • NPI 1912452939
  Medicare reassignment Care Compare group NPD
• Mak Anesthesia Georgia, LLC

  • Anesthesiology Physician
  • Kennesaw, GA
  • NPI 1609390103
  Medicare reassignment NPD

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

• Wellstar North Fulton Hospital, Inc

  • General Acute Care Hospital
  • Roswell, GA
  • NPI 1750312997
  Care Compare affiliation

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

{
    "created_epoch": "1478131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478131200000",
    "number": "1083166383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276 HARMONY LAKE DR",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301154781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 HARMONY LAKE DR",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301154781",
            "telephone_number": "404-488-5590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODI",
        "first_name": "KHUSHBU",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-03",
        "last_updated": "2016-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN202188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Amelia Minick, DC
• Aimee M Mitchell, PHYSICIAN ASSISTANT
• Leah Mitchell
• Tia Marie Mitcheltree
• Crystal Mizell
• Mackenzie Rylee Modica
• Devera Moeller, PHARMD
• Poya Moghadam, DMD
• Monac Mobility LLC
• Grant Herron Moody, MD

• Certified Registered Nurse Anesthetist in Canton, GA
• Providers in Canton, GA by specialty
• Certified Registered Nurse Anesthetist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.