NPIMap

Individual provider Active NPI

Prasanna Sampurna Srinagesh, M.D.

  • Nephrology Physician
  • Waycross, GA
National Provider Identifier
1104002666
Registry record updated Nov 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
66648 Issued in GA
Practice address
220 Uvalda St
Waycross, GA 31501-4569
Phone
(912) 285-2053
NPI assigned
Jan 15, 2008
Last updated
Nov 7, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 046093 CT
Nephrology Physician 207RN0300X 66648 GA Primary
Hospitalist Physician 208M00000X 046093 CT

Addresses

Primary practice location

220 Uvalda St
Waycross, GA 31501-4569

Mailing address

824 Saint Marys Dr
Waycross, GA 31501-3245
Phone (347) 804-4230

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111005000769 GA Practitioner - NephrologyPractitioner - Internal Medicine 2264518026 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

415 S Dixon St
Alma, GA 31510-3146
Phone (912) 632-8010

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.47 of 100Reported as group
Quality
98.55
Promoting interoperability
99
Improvement activities
40
Cost
71.88

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
046093CTMDInternal Medicine Physician
66648GAMDNephrology Physician

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AACHAD/Endpoint/AACHAD

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1200355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352246400000",
    "number": "1104002666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 SAINT MARYS DR",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315013245",
            "telephone_number": "347-804-4230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 UVALDA ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315014569",
            "telephone_number": "912-285-2053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRINAGESH",
        "first_name": "PRASANNA",
        "middle_name": "SAMPURNA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-15",
        "last_updated": "2012-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "046093",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "66648",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CT",
            "license": "046093",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

Verify at the official NPI Registry.